Reducing HAPIs in the ICU with a Turn Team

Abstract Purpose: The purpose of this quality improvement (QI) project was to decrease hospital-acquired pressure injury (HAPI) rates within an Intensive Care Unit (ICU) by implementing a two-nurse turning and repositioning schedule. Background: The QI project was implemented in a 24-bed Medical-Surgical ICU at a for-profit community hospital in Northwest Houston, Texas, in the United States of America. The project was developed and initiated at the project site because there was an increase in the HAPI rate above the organization’s target rate of zero. Methodology: Baseline HAPI rates and turning charting compliance were obtained. A baseline Likert scale survey was distributed to staff to assess perceived abilities and compliance with turning patients every two hours. The project lead, unit manager, director, skin champions, and charge nurses introduced the two-nurse turning and repositioning schedule and implementation plan to the staff during unit huddles and staff meetings. The project lead tracked the data and modified the project as needed using the Plan-Do-Study-Act method. During the three-month implementation phase, monthly project data results and updates were provided to unit staff and key stakeholders. Results: The HAPI rate for pre-intervention was 2.38%, and the post-intervention rate was 1.68%. There was an overall improvement in Likert scale confidence scores of perceived abilities and compliance with turning patients every two hours. Implications: Reducing HAPI can lead to decreased length of stay, improved patient outcomes, reduced risk of infection and sepsis, and reduced hospital costs. The QI process increases the ability of nurses to adhere to the quality standard of turning ICU patients every two hours. Implementing the two-nurse turning and repositioning schedule should be considered, as it promotes improved patient care and teamwork.