Systematic ReviewResearch

More frequent turning didn't clearly prevent pressure injuries; the clearer signals were sensor reminders and OR micromovement

The Cochrane database of systematic reviews (PubMed)Jun 4, 2026

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Brief summary

A Cochrane review of 11 trials found little certain evidence that more frequent repositioning prevents pressure injuries, while wearable-sensor reminders and operating-room micromovement showed more promising, though still limited, signals.

What NurseJet pulled from the source

This second update of a Cochrane review pooled 11 randomized trials involving 4,462 adults aged 18 to 90 in acute and aged-care settings to test repositioning regimens for pressure injury prevention. Comparisons of different turning frequencies were inconclusive: 2-hourly versus 4-hourly repositioning showed no clear difference (RR 1.05, 95% CI 0.79 to 1.39; 4 trials, 1,104 participants), rated very low certainty. A single ICU trial of real-time wearable patient sensors with visual repositioning reminders versus standard care reported fewer pressure injuries (RR 0.28, 95% CI 0.10 to 0.75; 1,226 patients; moderate certainty). Micromovement in the operating room also suggested a reduction (RR 0.28, 95% CI 0.11 to 0.67; 2 trials, 477 participants; low certainty, few events), while prone positioning in the ICU was associated with more pressure injuries than supine (RR 4.55, 95% CI 2.31 to 8.98; low certainty). Most of the evidence was low or very low certainty.

Why this matters for nurses

Repositioning is one of the most time-consuming parts of skin care, and units often standardize on a fixed turn schedule such as every two hours. This review suggests the exact frequency may matter less than assumed, and that the clearest benefit came from technology prompting repositioning rather than the clock alone. Because the evidence base is thin and mostly low-certainty, it argues for humility more than a protocol overhaul.

Bedside takeaway

Worth knowing that 2-hourly versus 4-hourly turning showed no clear difference in pressure injuries, while sensor-based repositioning reminders showed the strongest signal and prone ICU patients had higher risk.

Explain this for my unit

Key takeaways

Across 11 trials and 4,462 adults, more frequent repositioning did not clearly reduce pressure injuries: 2-hourly versus 4-hourly turning showed no significant difference (RR 1.05, 95% CI 0.79 to 1.39).
The strongest signal came from one ICU trial where wearable sensors with visual repositioning reminders reduced pressure injuries (RR 0.28, 95% CI 0.10 to 0.75; moderate certainty).
Operating-room micromovement suggested fewer pressure injuries (RR 0.28, 95% CI 0.11 to 0.67), but events were few and certainty was low.
Most of the evidence was low or very low certainty, and no trials reported quality of life, procedural pain, or patient satisfaction.

Practice implications

Keep repositioning as standard care, but recognize the evidence does not strongly favor one turning interval over another, so individualize frequency to skin assessment and risk rather than treating a rigid two-hour rule as proven. Where wearable repositioning-reminder systems are in use, support them, since the one ICU trial testing them showed a reduction. In the OR, micromovement and pressure-redistribution measures are reasonable adjuncts, and be alert that prone patients in the ICU may be at higher risk and need closer skin surveillance.

Limitations & cautions

Most included trials were small and rated low or very low certainty, so the findings are uncertain and the apparent benefits of sensor reminders and micromovement each rest on limited data. The wearable-sensor result came from a single ICU trial, and no trials reported quality of life, procedural pain, or patient satisfaction. Economic data were sparse, drawn from two older nursing-home evaluations, limiting conclusions about the relative costs of different regimens.
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Citations

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The Cochrane database of systematic reviews (PubMed)

The Cochrane database of systematic reviews (PubMed). Repositioning for pressure injury prevention in adults.

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https://pubmed.ncbi.nlm.nih.gov/42240176/

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This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Frontiers in Medicine (PubMed)Jun 23, 2026Research Article

In a prospective self-controlled study of 42 awake mechanically ventilated ICU patients, closed-system suctioning was followed by a sharp rise in self-reported dyspnea that largely resolved within 5 minutes, and this worsening occurred even though oxygen saturation went up.

ICUAI summaryReview source

Research ArticleResearchWorkflowAI summary · original source linked below

Endotracheal suctioning is a routine airway care procedure in mechanically ventilated patients, but its immediate effect on how breathless patients feel has not been well quantified. In this prospective self-controlled observational study conducted from May to October 2025 in a tertiary ICU in Sichuan Province, China, awake mechanically ventilated adults with a Richmond Agitation-Sedation Scale score of 0 to +1 who required closed-system suctioning were enrolled. Dyspnea was assessed with the Dyspnea Visual Analog Scale (D-VAS, 0 to 10) before suctioning (T0), immediately after (T1), and 5 minutes after (T2), while peripheral oxygen saturation (SpO2) and heart rate were recorded at the same times. Fifty-three suctioning procedures from 42 patients were included. D-VAS scores rose from 2.8 plus or minus 1.9 at T0 to 6.4 plus or minus 2.1 at T1 (mean increase 3.6, 95 percent CI 3.1 to 4.1, P less than 0.001), then fell to 3.2 plus or minus 1.7 at T2 (P less than 0.001 versus T1). Dyspnea worsened in 92.5 percent of procedures at T1, and 15.1 percent had not returned to baseline at T2. Even though SpO2 rose from 97.2 plus or minus 2.1 percent to 99.1 plus or minus 1.3 percent at T1, dyspnea worsened substantially, pointing to a possible dissociation between oxygenation and subjective respiratory distress. The authors conclude that closed-system suctioning may cause clinically significant but transient worsening of dyspnea that appears independent of oxygenation, and that individual dyspnea assessment during routine suctioning warrants attention, while noting the study was a single-center convenience sample.

Key takeaways

Across 53 closed-system suctioning procedures in 42 awake ventilated ICU patients, self-reported dyspnea rose sharply immediately after suctioning (D-VAS 2.8 to 6.4, mean increase 3.6, P less than 0.001) and largely settled by 5 minutes (3.2).
Dyspnea worsened in 92.5 percent of procedures right after suctioning, and 15.1 percent had not returned to baseline 5 minutes later.
Oxygen saturation actually increased with suctioning (97.2 percent to 99.1 percent), yet patients still felt more breathless, suggesting SpO2 and subjective distress can move in opposite directions.
The authors call the worsening clinically significant but transient and recommend assessing individual patients' dyspnea during routine suctioning.

Why this matters on shift

Suctioning is one of the most frequent things ICU nurses do for ventilated patients, and it is easy to assume that a stable or rising oxygen saturation means the patient is comfortable. This study may matter for critical care nurses because it shows that awake ventilated patients can feel markedly more breathless right after suctioning even when their SpO2 improves.

Bedside takeaway

Worth knowing that in a small ICU study, closed-system suctioning caused a sharp but short-lived rise in patient-reported breathlessness even as oxygen saturation rose, so a good SpO2 may not mean an awake ventilated patient feels comfortable.

Nursing implications

For ICU nurses, the findings suggest watching for and, where possible, asking about breathlessness around suctioning rather than relying on the oxygen saturation number alone, since most patients in this study felt worse immediately afterward. Knowing the distress is usually brief but occasionally lingers can support brief reassurance and reassessment before assuming an awake ventilated patient is at ease.

Limitations & cautions

This was a single-center convenience sample of only 42 patients and 53 procedures, with no prospective sample size calculation and a one-dimensional dyspnea scale, so the estimates are preliminary. It enrolled only awake, lightly sedated patients able to self-report, so the findings may not apply to more deeply sedated patients, and confirmatory multicenter studies are needed.
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Citations · exact source links

Frontiers in Medicine (PubMed). Impact of closed-system suctioning on self-reported dyspnea in mechanically ventilated patients: a prospective observational study.

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BMJ Quality & Safety (PubMed)Mar 13, 2026Research Article

In a multicentre randomised controlled simulation trial with 82 nurses, independent double-checking detected more medication administration errors than single-checking overall, but the benefit was limited to experienced nurses, with no significant improvement among nurses with under five years of experience.

Med-Surg PedsAI summaryReview source

Research ArticleResearchMedication SafetyAI summary · original source linked below

Double-checking medication administration is a common hospital safety practice, and independence between the two checkers is thought to be the key to its effectiveness, yet there has been no empirical evidence that independent double-checking (IDC) detects errors better than a single-nurse check. This multicentre randomised controlled simulation trial enrolled 82 nurses from two paediatric hospitals in 41 two-hour simulations, each involving two nurses who administered medication sets containing embedded errors under both single-checking and IDC conditions, with condition order and medication sets randomised. Across 1,160 dose administrations with 640 error-detection opportunities, nurses detected 72.2 percent of errors (95 percent CI 68.6 to 75.5). Overall, IDC yielded an 11 percent higher error detection rate than single-checking (adjusted incidence rate ratio 1.11, 95 percent CI 1.01 to 1.21, P = 0.02; 77.7 percent for IDC versus 66.3 percent for single checks). That benefit was limited to experienced nurses: among early career nurses (under 5 years of experience) IDC produced no significant improvement (adjusted incidence rate ratio 0.98, 95 percent CI 0.86 to 1.11, P = 0.7), while experienced nurses showed a 26 percent improvement (adjusted incidence rate ratio 1.26, 95 percent CI 1.11 to 1.44, P less than 0.001). Evidence of social loafing was seen, particularly among early career nurses, whose detection was 26.0 percent higher when single-checking than in the role of first checker in IDC, and IDC required significantly more time (mean difference 4.96 minutes per medication set, P less than 0.001). The authors conclude that, given its inconsistent benefits, resource demands, and susceptibility to social loafing, IDC may be unsuitable as a universal safety strategy, and that strengthening single-checking competence and clinical judgement may be a more effective, scalable approach.

Key takeaways

In 41 two-hour simulations, 82 nurses from two paediatric hospitals administered medication sets with embedded errors under both single-checking and independent double-checking conditions.
Overall, independent double-checking detected 11 percent more errors than single-checking (adjusted incidence rate ratio 1.11, 95 percent CI 1.01 to 1.21, P = 0.02; 77.7 percent versus 66.3 percent).
The benefit was limited to experienced nurses (26 percent improvement, P less than 0.001); among nurses with under five years of experience there was no significant improvement (P = 0.7).
Independent double-checking took about 5 minutes longer per medication set (mean difference 4.96 minutes, P less than 0.001), and social loafing lowered early career nurses' detection in the first-checker role.

Why this matters on shift

Independent double-checking is widely mandated and consumes considerable nursing time, yet its real benefit has been assumed rather than measured. This study may matter for nurses and safety leaders because it provides direct evidence that the practice helps experienced nurses catch errors but does not reliably help less experienced ones, which challenges applying it as a blanket rule.

Bedside takeaway

Be aware that in a simulation trial, independent double-checking caught more medication errors than single-checking only for experienced nurses, with no benefit for nurses under five years and signs of reduced individual vigilance when checking in pairs.

Nursing implications

For nurses and unit leaders, the findings suggest that independent double-checking is not automatically safer for every nurse or situation and can be undermined by social loafing, where a second checker relaxes their own vigilance. The results support investing in each nurse's own checking competence and clinical judgement, and reserving double-checks for the highest-risk medications, rather than treating a second signature as a guaranteed safety net.

Limitations & cautions

This was a simulation trial rather than a study of real bedside administration, so behavior with actual patients and consequences may differ, and it involved 82 nurses from two paediatric hospitals, which may limit how far the results extend to adult or other settings. Detecting deliberately embedded errors in a study scenario may not fully reflect the interruptions and workload of everyday practice.
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Citations · exact source links

BMJ Quality & Safety (PubMed). Is independent double-checking superior to single-checking in medication administration error detection? A randomised controlled simulation trial.

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Nurse Educator (PubMed)Jul 7, 2026Research Article

In a retrospective program evaluation across 13 semesters, a standardized, experiential medication dosage calculation program that combined instruction, simulation, and assessment was associated with significantly higher first-attempt pass rates among nursing students than the period before it was introduced.

Leadership Med-SurgAI summaryReview source

Research ArticleResearchMedication SafetyNew Grad FriendlyAI summary · original source linked below

Medication dosage calculation errors are a persistent patient-safety concern and a barrier to nursing student progression, and this program had seen significant declines in pass rates, with more than half of students across program levels failing their initial dosage calculation assessments. Educators at a nursing program implemented a standardized, experiential dosage calculation initiative that integrated instruction, simulation, and assessment, then conducted a retrospective evaluation of medication dosage calculation outcomes across 13 semesters, comparing the 4 semesters before implementation with the 9 semesters after. First-attempt pass rates were compared using a t test to assess program-level change over time. Mean semester-level pass rates were significantly higher after implementation (t(3.79) = -4.18, P = 0.016), and the post-implementation semesters consistently met or exceeded the program benchmark. The authors conclude that a standardized, experiential approach to dosage calculation instruction was associated with sustained improvements in program-level outcomes and offers practical guidance for nurse educators seeking data-driven curricular changes that support medication safety and student progression.

Key takeaways

More than half of students across program levels had been failing their initial medication dosage calculation assessments before the change.
Educators introduced a standardized, experiential dosage calculation program combining instruction, simulation, and assessment.
A retrospective evaluation compared 4 pre-implementation semesters with 9 post-implementation semesters using a t test.
Mean semester-level first-attempt pass rates were significantly higher after implementation (t(3.79) = -4.18, P = 0.016) and consistently met or exceeded the program benchmark.

Why this matters on shift

Dosage calculation competency underpins safe medication administration, yet many nursing students struggle to pass these assessments, which can delay progression and signal a downstream safety risk. This study may matter for nurse educators and new nurses because it links a structured, hands-on teaching approach to sustained improvement in first-attempt pass rates.

Bedside takeaway

Worth knowing that a standardized, hands-on dosage calculation program was linked to higher first-attempt pass rates for nursing students across 13 semesters.

Nursing implications

For nurse educators and preceptors, the findings suggest that building dosage calculation skills through repeated, experiential practice tied to instruction, simulation, and assessment, rather than one-off lessons, may raise competency and support medication safety. For students and new graduates, it reinforces that dosage calculation is a skill strengthened by structured practice over time.

Limitations & cautions

This was a retrospective, single-program evaluation comparing pass rates before and after one curricular change, without a separate control group, so other factors over the 13 semesters could have contributed. Because it reports program-level pass rates rather than individual student outcomes or actual medication errors at the bedside, it does not show whether the gains reduced real-world administration errors.
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Citations · exact source links

Nurse Educator (PubMed). Innovative Educational Strategies to Improve Dosage Calculation Competency in a Nursing Program.

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Key takeaways

Practice implications

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More updates for this clinical area

Closed-system suctioning triggered a sharp but short-lived rise in patient-reported dyspnea even as oxygen saturation went up

Independent double-checking caught more medication errors than single-checking only for experienced nurses in a simulation trial

A standardized, hands-on dosage-calculation program raised nursing students' first-attempt pass rates across 13 semesters