Does implementing a turn team on hospital units aid in preventing pressure-related injuries as compared to standard of care, without a turning team?https://knowledgeconnection.mainehealth.org/nurseresidency/1099/thumbnail.jp

Grant, Johnna, RN

Thompson, Paige, RN

English

MaineHealth Knowledge Connection

MaineHealth MaineHealth Knowledge Connection Nurse Residency 5-2024 Bean 5 Turn Team: Improves Turing Interventions & Reduces HAPI Rates Paige Thompson RN Johnna Grant RN Follow this and additional works at: https://knowledgeconnection.mainehealth.org/nurseresidency  Part of the Nursing Commons Bean 5 Turn Team:Improves turning interventions & reduces HAPI ratesPaige Thompson, RN and Johnna Grant, RNBackground- According to Miller et. al, “Hospital-acquired pressure injuries (HAPIs) increase patient mortality and length of stay (LOS)” (2019).- What is a turn team?- The turn team consists of two assigned caregivers that round on each assigned patient and reposition the patient onto their opposite side and provide incontinence care, followed by documentation of cares (Grimes and Choma, 2020).- The charge nurse is responsible for indicating patient’s who have a Braden Scale < 14 and creating an assignment for nurses to turn these patients.What is a Turn Team? Bean 5(Lucas et al., 2023)Bean 5 Data Timeline● Pre-turn team study: 16 HAPI’s on Bean 5 from 5/1/22-2/28/22● Goal: Reposition patients with braden scale of <14 q2h, 12 times a day, 100% of the time to decrease the number of unstageable, stage 3 or greater pressure injuriesBean 5 Data Timeline● Root cause of PIs on Bean 5: reduced resources impacting workflow = patients not being repositioned, skin not being assessed and documentation not being completed● Outcome: 1710 patients included in study, turning interventions increased from average of 1.42 to 8.14 q2h. ● Post study: 0 HAPI’s 4/2/22-12/1/22(Lucas et al., 2023)Background The Braden Scale widely utilized to assess pressure injury risk and looks at Activity, Sensory Perception, Nutrition, Friction/Shear and moisture. (Braden and Bergstrom, 1988)Turn Team in Action PICOT Question Does implementing a turn team on hospital units aid in preventing pressure-related injuries as compared to standard of care, without a turning team?- Purpose: The purpose of this article was to evaluate the effectiveness of different turning interventions on the incidence of pressure injuries - Population: At-risk adult individuals that do not currently have a pressure injury - Methods: As a systematic review, this article reviewed randomized control trials, pre and post studies and interrupted time series studies. This article reviewed the impact of repositioning frequency, the use of repositioning systems and use of turning teams. The researchers utilized a pre-designed extraction tool and analyzed using RevMan. - Results: Half of the studies were conducted in intensive care units. Pressure injury incidence was 11% with the use of a turn team versus 20% using usual care. A 51% reduction in the odds of a pressure injury developing in the favor of using a turn team.  - Conclusions: This article concluded that more frequent repositioning as well as the use of a turn team reduce pressure injury incidence. - Level of evidence: Level I, A quality. “Turn Teams: How Do You Prevent Pressure Injuries?”“Reduction of Hospital-acquired Pressure Injuries Using a Multidisciplinary Team Approach: A Descriptive Study”- Purpose: To understand the common causes of HAPIs and create a plan to prevent them, and reduce them to zero occurrences- Population: Hospital-wide–all inpatient units and perioperative patients- Methods: Document all HAPI occurrences, reduce the preventable HAPIs to zero occurrences, and implement the changes hospital wide- Results: Since implementation, there has been an 89% reduction in HAPI’s. - Conclusions: The multidisciplinary pressure injury prevention team can reduce hospital acquired pressure injuries- Level of evidence: Level III, B quality.“Estimating the value of repositioning timing to streamline pressure injury prevention efforts in nursing homes: A cost-effectiveness analysis of the 'TEAM-UP' clinical trial”- Purpose: The purpose of this article was to analyze the cost-effectiveness of the pressure-related injury prevention protocols according to TEAM-UP randomized controlled trial findings. - Population: nursing home residents. - Methods: Researchers compared Q2, Q3, and Q4 hour repositioning intervals to prevent pressure related injuries in nursing home residents over one year utilizing the TEAM-UP trial data.- Results: Two hour repositioning for patients delivers the least amount of risk of pressure injury formation, but also comes at the greatest cost. Reducing the frequency of repositioning to every 3 or 4 hours saves nursing costs substantially, however, may expose residents to an increased risk of pressure related injury formation. - Conclusions: The standard of care for repositioning patients should remain every two hours in order to reduce the risk of pressure injury formation. - Level of Evidence: Level 1, A quality. Recommendations for Practice - Based on the evidence we reviewed, we believe turning teams should be implemented in every unit at Maine Medical Center. - When reviewing the evidence, studies show that the implementation of a turning team reduces the incidence of pressure injuries. - In order to implement the turning team on units that do not have one, the nursing director should meet with other unit nursing directors who have implemented turning teams on their respective unit- Data, results and methods should be shared from turning-team units to units looking to implement this strategy - Aspects of turn team that have worked on resident units should be shared with new units in order to support transitioning unitsReferencesAvsar, Pinar, et al. “Repositioning for Preventing Pressure Ulcers: A Systematic Review and Meta-Analysis.” Journal of Wound Care, vol. 29, no. 9, 2 Sept. 2020, pp. 496–508, www.magonlinelibrary.com/doi/full/10.12968/jowc.2020.29.9.496, https://doi.org/10.12968/jowc.2020.29.9.496.Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden Scale for Predicting Pressure Sore Risk. Nurs Res. 1987 Jul-Aug;36(4):205-10. PMID: 3299278.Grimes, A., & Choma, R. (2020). The Turn Team Initiative: A Hospital Acquired Pressure Injury (HAPI) Reduction Technique. Providence St. Joseph Health Digital COmmons.Kennerly SM, Sharkey PD, Horn SD, Alderden J, Yap TL. Nursing Assessment of Pressure Injury Risk with the Braden Scale Validated against Sensor-Based Measurement of Movement. Healthcare (Basel). 2022 Nov 21;10(11):2330. doi: 10.3390/healthcare10112330. PMID: 36421654; PMCID: PMC9690319.Lucas L, Curtis J, Sparks A, Davis C, St. Peter H, 2023. Maine Medical Center, MaineHealth.  Unpublished work.Miller MW, Emeny RT, Freed GL. Reduction of Hospital-acquired Pressure Injuries Using a Multidisciplinary Team Approach: A Descriptive Study. Wounds. 2019 Apr;31(4):108-113. Epub 2019 Feb 14. PMID: 30802207; PMCID: PMC6586476.Padula WV, Crawford SA, Kennerly SM, Yap TL. Estimating the value of repositioning timing to streamline pressure injury prevention efforts in nursing homes: A cost-effectiveness analysis of the 'TEAM-UP' clinical trial. Int Wound J. 2023 Nov 1;21(3):e14452. doi: 10.1111/iwj.14452. Epub ahead of print. PMID: 37909183; PMCID: PMC10895199.“Turn Teams: How Do You Prevent Pressure Injuries? - ProQuest.” Www.proquest.com, www.proquest.com/openview/a648f69aa5b9552d56a36f7b02596b9e/1?pq-origsite=scholar. Accessed 24 Apr. 2024.

Bean 5 Turn Team: Improves Turing Interventions & Reduces HAPI Rates

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Bean 5 Turn Team: Improves Turing Interventions & Reduces HAPI Rates

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