Importance of routine turning on Spinal Injury Patients

One of the simplest ways of improving the care and rehabilitation process for spinal cord injury patients is to adopt a schedule of routine turning. This can prevent further complications and improve the patient’s long term health prospects.

Spinal injuries in triage and general care

Spinal injuries will almost invariably be triaged within an A&E department, with subsequent examination occurring on the ward. In both environments, staff will not necessarily have specific spinal injury training or experience and may not thus be aware as to the need for or approach to turning. This can create problems long before the patient is transferred to a specialist unit, wherein they are to undergo a specifically designed rehabilitation programme. This period prior to entering specialist care may thus result in the patient spending longer in hospital; it may delay rehabilitation; and may engender or exacerbate long term issues that lead to re-admission.

Why turning does not always occur

With a spinal injury, the importance of routine turning is to help prevent pressure ulcers and respiratory infections. This should usually occur every two hours for critical cases, but can be carried out every three to four hours for a significant percentage of spinal patients.

However, within a general ward setting, turning routinely occurs at a reduced frequency and, in some cases, not at all. The main reason for this is simple: insufficient staffing levels. Turning takes both considerable time and manpower. The majority of turns are carried out manually or through the use of hoists or sliding sheets. In these environments, mechanical turning beds may represent the solution, relieving the pressure on staff.

 

Showing large number of people needed to turn a patient

An Image to show how many people it requires to correctly turn a patient. This can be even more without a mechanical turning bed.

The importance of routine turning

All staff caring for those with spinal injuries should be made aware of the importance of routine turning and how to safely and correctly implement turns. Incorrectly re-positioning the patient can cause just as much harm as failing to perform the turn.

When a patient has been turned they need to be accurately positioned in order to limit the chance of associated problems. They should be placed at an angle of no greater than 30 degrees; otherwise there is an increased risk of skin shearing. At this angle they will still be able to use their upper body when eating and drinking. Their body mass will be more evenly distributed, thereby minimising direct pressure on the trochanter of the hip.

 

 

Successfully turning a patient on a routine basis will greatly assist in limiting complications. It reduces the length of time during which pressure is sustained by weight-bearing parts of the body and minimises fluid stasis in the organs.

Routine turning can thus substantially improve a patient’s chances of recovery and can limit the risk of additional problems. The use of mechanical turning beds can provide patients with a far better standard of care whilst reducing the demands placed upon clinical staff.

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