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The performance improvement process was used to develop and implement a dedicated Turn Team to decrease the incidence of unit-acquired pressure injuries. Outcomes as a result of the change are reviewed.
Pressure injury prevention requires an interprofessional team approach and organizational support (National Database of Nursing Quality Indicators, 2019). Early nursing care interventions play a significant role in pressure injury prevention and management across the healthcare setting. The National Pressure Ulcer Advisory Panel (NPUAP, 2016) recommended performing skin assessments within 8 hours of patient admission using a risk assessment tool (e.g., Braden Scale for Predicting Pressure Sore Risk; Prevention Plus, 2016) to identify persons at risk for pressure injury. In addition, a skin assessment should be completed every shift in the acute care setting. According to the NPUAP, patients who are considered at risk for pressure injuries include those who are bedfast or chairfast, or have fragile skin, previous or existing pressure injuries, decreased blood flow to the extremities, and pain in pressure points.
An individualized plan of care should be developed for patients based on their risk assessments. For example, if decreased mobility is a current problem, the plan of care should include turning and reposi- tioning the patient at regular intervals, and using a support surface. In addition to performance of a risk assessment, guidelines address skin care, nutrition, mobilization, and education as part of pressure injury prevention (NPUAP, 2016). Repositioning and mobilization interventions require nursing staff to turn and reposition all individuals at risk for pressure injury, choose a frequency for turning, avoid positioning the individual on areas with an existing pressure injury, and ensure the patient's heels are offloaded. At the medical-surgical unit that was the site for this quality improvement project, multiple interventions were followed without achieving a marked decrease in pressure injury occurrence. For example, appropriate support surfaces were in place and skin care products were used consistently, including pH-balanced skin cleansers and moisture barrier creams. Nutrition consultation, assessment of adequacy of oral intake, and nutrition supplementation were implemented as needed. A literature review on the implementation of Turning Teams for pressure injury prevention was conducted by the unit's Patient Outcomes Facilitators (POFs). Study results suggested a decrease in the incidence of pressure injuries after the implementation of...