complex and multi-factorial problem that requires the vigilant and active involvement of staff and patient cooperation across the continuum of care (Australian Wound Management Association, 2012). .
In 2008, Krapfl and Gray conceded that sufficient evidence to support the frequency of repositioning was lacking. In their review, it was suggested that four hourly repositioning on a pressure redistribution mattress (PRM) was just as effective as two hourly repositioning on a standard mattress. They stressed, however, that multiple factors influence the pressure on tissue surfaces when patients are placed in certain positions and that repositioning schedules should be based on individual client assessments rather than generalized recommendations (Krapfl & Gray, 2008). Their paper also concurred with the argument of many wound experts that some pressure ulcers are simply unavoidable, particularly in high risk patients, the elderly and patients in palliative care as these patients have reduced circulation and poor healing ability (Krapfl & Gray, 2008). This position was later reinforced by Wallis in 2010, who also agreed that that some patient situations make pressure ulcers inevitable, particularly those who refuse to cooperate with repositioning and those with hemodynamic instability that precludes turning or repositioning. At the time, Krapfl and Gray (2008) had insufficient evidence to determine whether a 30 ° lateral position was superior to a 90 ° lateral position, indicating that further studies on repositioning schedules and positioning angles were necessary to make valid recommendations.
One year later, in 2009, the Queensland Government published a set of guidelines that encouraged health care settings to initiate repositioning every two hours. Similar to Krapfl and Gray (2008), the guidelines stated that while this was a general recommendation, repositioning was just one aspect of pressure ulcer prevention and the schedule should take into account the patient's medical condition, comfort, overall care plan and support surface being used (Queensland Government, 2009).
