Who Is Turning the Patients? A Survey Study

Purpose: This study examines whether nurses at a 240-bed hospital can correctly identify patients at high risk for skin breakdown and if nurses have adequate resources to reposition high-risk patients. Background: About 2.5 million persons in the U.S. are treated annually for pressure ulcers. CMS no longer pays for hospital-acquired ulcers. The study facility had a pressure ulcer prevalence rate of 3.57 %; 0 % was desired. Norton risk assessment scores are automatically calculated by a computerized documentation system and are the primary means to communicate skin risk; it was thought that nurses rarely viewed scores.   

Methods: Face-to-face interviews were conducted for four days. Sample included 101 nurses from eight acute care units, all shifts. An IRB-approved survey instrument consisted of demographic questions and patient assignment questions including: whether nurse received information about skin risks, which patients were believed at high risk for skin breakdown, whether nurse knew Norton scores for patients, whether patients were repositioned and how often, and who completed repositioning. Patients’ Norton scores were extracted from computer records. SPSS was used for descriptive statistical analysis.

Results: Most nurses did not know their patients’ Norton scores (73%). About 60% of nurses reported turning their high risk patients every 2-4 hours. The repositioning was completed most often by RNs alone (39%), RN and CNA (36%) and by patient themselves (35%). Insufficient time/help to reposition was reported on five patients. Assessment by nurses on patient’s skin risk status was incorrect 116 out of 348 patients (33%). Nurses predicted high risk when low 41%, low risk when high 40%.

Conclusions: Nurses report adequate resources to reposition patients. Nurses are not aware of patients’ Norton scores and have poor accuracy identifying patients’ risk status. Future study: 1) communicating risk 2) how accurate risk assessment impacts care and efficient use of resources.