Strategies of Repositioning for Effective Pressure Ulcer Prevention in Immobilized Patients in Home-Based Palliative Care: An Integrative Literature Reviews

An integrative literature review was conducted to assess available scientific evidence about best strategies of repositioning along with medical devices in the prevention of pressure ulcers in immobilized patients in home-based palliative care. It is important to have evidence-based strategies and principles to prevent pressure ulcers in immobilized patients receiving home-based palliative care. However, there is a lack of consistency in protocol especially in Thailand. This review was done first by searching related literature through electronic databases including Cochrane, PubMed, Web of Science, Scopus, MEDLINE, ProQuest, and CINAHL that were published between 2010 and 2019. The PRISMA guidelines were used to structure the review. The findings of the review indicated that the best method or repositioning was 30° lateral tilt every 2 to 3 hours. However, alternative strategies, such as a combination involving medical devices such as a special mattress or automatic bed that can extent the duration of repositioning from every two hours to three to four. There is a need for further research examining the effectiveness of 3-hourly repositioning with use of a medical device that could reduce risk of pressure ulcers while reducing the burden on family caregiver. Keywords: Repositioning, Pressure ulcer, Prevention, Immobilized patients, Palliative care