Turn Team: The Implementation and Impact on a Step-down Unit -Scripps Mercy Hospital ,San Diego,California

Repositioning of the patient with reduced mobility is a key intervention for prevention of hospital acquired pressure ulcers (HAPUs). ¹  Although the “Q two hour turn” is a standard intervention, the ability of the individual healthcare provider to perform turns consistently varies due to high patient acuities, staffing variances and changing clinical circumstances.  In 2009 three Scripps- Mercy staff nurses proposed a team approach to accomplishing two hour turns.  Nursing leadership supported the proposal as a strategy to reach the Collaborative Alliance for Nursing Outcomes (CALNOC) benchmarks for HAPUs. The proposal was implemented on the step-down unit in October 2009.

 The turn team structure is on every shift all nursing staff is assigned to one of 3 teams. For staff safety the teams have a minimum of 3 members. The teams have an assigned captain to assure completion of assigned turns. The RNs list their patients who need turn assist on a dry erase board.  Each team performs 2 of the 6 turns in their 12 hour shift. Initial staff resistance about the time this practice would take has resolved as team efficiency has increased.

Scripps- Mercy hospital performs quarterly CALNOC prevalence surveys to monitor nursing performance related to HAPU rates. Following implementation of the turn team, the next 3 CALNOC surveys revealed 0% HAPU for the step-down unit. The turn team practice has yielded other positive outcomes for this unit: a decrease in staff injuries related to turning, staff reports of increased pride for their part in reducing HAPU rates, as well as manager reports of patients and their families expressing heartfelt appreciation for the turn team. The team also promotes timely incontinence care which may contribute to the reduced HAPU rate as moisture from incontinence enhances friction and shear forces against the skin. ²