Turning for Ulcer ReductioN: a multisite randomized clinical trial in nursing homes

J Am Geriatr Soc. 2013 Oct;61(10):1705-13. doi: 10.1111/jgs.12440. Epub 2013 Sep 19.


Objectives: To determine optimal repositioning frequency of nursing home (NH) residents at risk for pressure ulcers (PrUs) when cared for on high-density foam mattresses.

Design: Multisite, randomized, clinical trial, known as Turning for Ulcer ReductioN (TURN Study).

Settings: NHs in the United States (n = 20) and Canada (n = 7) using high-density foam mattresses.

Participants: Consenting residents (N = 942) aged 65 and older without PrUs at moderate (scores 13-14) or high (scores 10-12) risk of PrUs according to the Braden Scale.

Intervention: Participants were randomly allocated using risk stratification (moderate vs high) to a repositioning schedule (2, 3, or 4 hour) for 3 weeks. Blinded assessors assessed skin weekly.

Measurements: PrU incidence (coccyx or sacrum, trochanter, heels).

Results: Participants were mostly female (77.6%) and Caucasian (80.5%) and had a mean age of 85.1 ± 7.7. The most common diagnoses were cardiovascular (76.9%) and dementia (72.5%). Nineteen (2.0%) participants developed superficial PrUs. There was no significant difference (Wilcoxon test for ordered categories) in PrU incidence (P = .68) according to repositioning group (2 hour, 8/321, 2.5%; 3 hour, 2/326, 0.6%; 4 hour, 9/295, 3.1%), nor was there a statistically significant difference in the incidence of PrU between the high and moderate-risk groups (P = .79). Also, PrU incidence was not statistically significantly different between high-risk participants based on repositioning schedule (6/325, 1.8%, P = .90) or between moderate-risk participants based on repositioning schedule (13/617, 2.1%, P = .68).

Conclusion: There was no difference in PrU incidence over 3 weeks of observation between those turned at 2-, 3-, or 4-hour intervals in this population of residents using high-density foam mattresses at moderate and high risk of developing PrUs when they were repositioned consistently and skin was monitored. This finding has major implications for use of nursing staff and cost of NH care.

Keywords: Turning for Ulcer ReductioN Study; nursing home; pressure ulcer prevention; repositioning.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Beds / adverse effects*
  • Beds / standards
  • Equipment Design
  • Equipment Failure
  • Female
  • Humans
  • Incidence
  • Male
  • Nursing Homes / supply & distribution*
  • Ontario / epidemiology
  • Pressure Ulcer / epidemiology
  • Pressure Ulcer / etiology
  • Pressure Ulcer / nursing*
  • Prognosis
  • Risk Factors
  • United States / epidemiology