Implementing Turn Rounds in the ICU

Abstract

Problem: Hospital acquired pressure injury rates in the Intensive Care Unit of a community hospital increased above a national average of 5%. Repositioning of vulnerable patients was a modifiable risk factor identified by key stakeholders. Purpose: The purpose of this initiative was to increase staff adherence to patient repositioning by removing barriers through the implementation of unit “turn-rounds” on dayshift. Methods: This project shifted patient repositioning to a simplified process where staff were encouraged to turn their patients at the top of even hours. Every even hour, a message was sent via the unit’s secure messaging system and care associates (CAs) circulated the unit to remind registered nurses to reposition their patients and assist them. Data collected included date and time of rounds, where rounds took place in the ICU, number of eligible patients, number of patients that were repositioned, and reasons if all eligible were not repositioned. Data was collected by CAs after each rounding period through an online survey on a secure data collection platform. Results: Data was collected for 14 weeks. The main structure goal of educating permanent CAs was met with 100% receiving one-to-one education. The process goal for this project was for CAs to circulate their assigned zone six times per shift. Weekly averages ranged from 0% to 54.7% with a mean of 21%. The outcome goal for this project was 100% of eligible patients repositioned during rounds. When rounds were completed, the weekly percentage of eligible patients repositioned ranged from 76.3% to 100% with a mean of 93.9%. No significant trends or shifts were identified in the data. Compliance with turn rounds was far below goal, but almost 100% of patients were repositioned when turn rounds were completed. Conclusions: High patient volumes and decreased staffing were the main barriers identified to conducting turn rounds.