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ppmc bootcamp 2019; oregon; portland; ppmc





Nurses are required to reposition patients at risk for HAPI every 2 hours, however finding timely assistance can be challenging, leading to increased length of time between, or missed turns. Previous studies have found that structured Turn Team assignments reduced HAPI rates up to 75%.


The purpose of this study is to investigate the implications of a team-initiated turning and repositioning technique every two hours. The study question was, “Does two-hour team nurse turning and repositioning rounds reduce incidence of HAPI in adult medical-surgical patients as compared to primary nurse initiated turning and repositioning?” This QI Project was exempt from IRB approval.


A Quality Improvement project using a convenience sample was conducted. An EPIC chart review was completed following the intervention period to assess HAPI incidence and charting compliance. Who was included? Adult 4G/4R patients with a Braden score of less than 18 and inability to independently reposition in bed. The primary care nurse is responsible for adding patients / updating the charge nurse on patient appropriateness for the turn team assignments each shift. What is the turn team? On the odd hours two assigned caregivers round on each assigned patient. They provide incontinence care, reposition the patient to their opposite side, then document cares and patient position in real time through EPIC “Quickchart flowsheet, Positioning tab”. Ideally, each caregiver is assigned one time slot per shift, with all other turns being consistently provided by other members of the team. Who assigns caregivers to the turn team? The charge nurse is responsible for making turn team assignments along with the upcoming shift assignment, and posts where most visible for the care team to see.


The turn team initiative greatly reduced the incidence of HAPIs. Since concluding the study, the unit has permanently adopted the intervention into their unit practices. This cost-neutral nursing intervention can be easily applied to all medical surgical units. Limitations: Conducting study at the start of the COVID-19 pandemic, which could have impacted average patient acuity, as well as overall unit census. Inconsistency in reporting HAPI’s via Datix Reporting System.



Conference / Event Name

2019 Nursing Boot Camp


Providence Portland Medical Center

The Turn Team Initiative: A Hospital Acquired Pressure Injury (HAPI) Reduction Technique

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Nursing Commons