Hospital-acquired Pressure Injury Prevention Assisted by a Leadership-supported Dedicated Turn-team

Critically ill patients are at high risk for hospital-acquired pressure injury development due to immobility and hemodynamic instability. In the 24-bed Cardiac Intensive Care Unit within an academic medical center, registered nurses have multiple competing responsibilities and priorities that reduced consistency and quality of patient repositioning, including movement from bed to chair. An inconsistent repositioning/out-of-bed schedule can prompt hospital-acquired pressure injuries to bony prominences.

To examine surface hospital-acquired pressure injury rates pre-post intervention implementation and assess perceived usefulness and added value of the turn-team in a high-acuity coronary intensive care unit that routinely utilized advanced life support technologies.

This project was a single unit, continuous improvement initiative. A nonclinical turn-team provided consistent repositioning/up-to-chair of patients to reduce hospital-acquired pressure injury incidence. Inferential statistics were used to assess pre-post surface hospital-acquired pressure injury rates and clinicians' surveys were analyzed descriptively.

In the postimplementation period, repositioning consistency increased, and the hospital-acquired pressure injury rate was reduced by 42% (P=.043). After adjusting for daily patient census, daily risk of surface hospital-acquired pressure injury changed from 6.74% to 4.03%, adjusted odds ratio 0.581 (95% confidence interval: 0.33, 1.02), P=.059. At 30 days, survey results reflected strong team collaboration and turn-team members support that enhanced clinical nurse productivity.

A dedicated turn-team was a valuable adjunct to patient positioning when busy nursing caregivers were unable to complete this important role at regular intervals. Clinical nurses and turn-team members worked well together to achieve patient care outcomes.