Body positioning of intensive care patients: Clinical practice versus standards

Objective: The routine turning of immobilized critically ill patients at a minimum of every 2 hrs has become the accepted standard of care. There has never been an objective assessment of whether this standard is achieved routinely. To determine if immobilized patients in the intensive care unit (ICU) receive the prevailing standard of change in body position every 2 hrs. To determine prevailing attitudes about patient positioning among ICU physicians. Design: Prospective longitudinal observational study. E-mail survey of ICU physicians. Setting and Participants: Convenience sample of mixed medical/surgical ICU patients at three tertiary care hospitals in two different cities in the United States. Random sampling of ICU professionals from a directory. Main Outcome Measures: Changes in body position recorded at 15-min intervals. Results. Seventy-four patients were observed for a total of 566 total patient hours of observation, with a mean observation time per patient of 7.7 hrs (range, 5-12). On average, 49.3% of the observed time, patients remained without a change in body position for >2 hrs. Only two of 74 patients (2.7%) had a demonstrable change in body position every 2 hrs. A total of 80-90% of respondents to the survey agreed that turning every 2 hrs was the accepted standard and that it prevented complications, but only 57% believed it was being achieved in their ICUs. Conclusions: The majority of critically ill patients may not be receiving the prevailing standard of changes in body position every 2 hrs. This warrants a reappraisal of our care of critically ill patients.