Who Is Turning the Patients? A Survey Study

Purpose:
This study seeks to establish if nurses at a 240-bed community hospital can correctly identify patients at high risk for skin breakdown and to determine whether nurses have the resources needed to reposition high-risk patients per protocol.

Background/Significance:
About 2.5 million persons in the U.S. are treated annually for pressure ulcers. CMS no longer pays for care of hospital-acquired ulcers. This facility conducts pressure ulcer prevalence studies and reported a rate of 3.57% to the NDNQI database at the time of the study; 0% was desired. Norton risk assessment scores are used to communicate skin risk at this facility and automatically calculated by a computerized documentation system; it was thought that nurses rarely viewed scores.

Methods:
Face-to-face interviews were conducted on all shifts for four days. Sample included 101 nurses from eight acute care units. An IRB-approved survey instrument consisted of demographic questions and patient assignment questions including: whether nurse received information about skin risks, which patients were believed at high risk for skin breakdown, whether nurse knew Norton scores for patients, whether patients were repositioned, who performed the repositioning and how many times that shift. Surveyors obtained patients' Norton scores from computer records and recorded whether the nurse correctly identified patients at high-risk for skin breakdown.

Results:
Most nurses stated they did not know their patients' Norton scores (73%). About 60% of nurses reported turning their high risk patients every 2-4 hours. The repositioning was completed most often by RNs alone(39%),RN and CNA(36%)and by patient themselves(35%). Reasons for not repositioning included: allowed to sleep(12), off unit(5), patient refused(4),not enough time(4),family refused(2), pain(2), not enough help(1),patient terminal care(1). Assessment by nurses on patient's skin risk status was correct 232 out of 348 patients(66%);116 out of 348 patients had incorrect assessments(33%). Nurses predicted high risk when low 41%, low risk when high 40%.

Conclusions and Implications for Practice:
Nurses report adequate resources for repositioning. Nurses are not aware of patients' Norton scores and have poor accuracy identifying patients' risk status. For future study: communicating risk, resource allocation, and nurses ability to balance pain, sleep, and patient needs with skin protection.