The effect of using a turn clock to cue patient repositioning for pressure ulcer prevention in an acute care setting
Authors:   , Wiens Julie 
Published: February 2023

Hospital-acquired pressure ulcers, a nursing care quality indicator, are becoming increasingly common in United States acute care facilities. In fiscal year 2007, the Centers for Medicare and Medicaid Services (CMS) recorded 257,412 “avoidable” Stage III and Stage IV pressure ulcers acquired in our nation’s hospitals on patients who were admitted to receive care for their primary diagnosis (CMS, 2007). Pressure ulcers are associated with pain and suffering, loss of function, increased length of stay, increased morbidity and mortality, and significant financial burden (Ayello & Lyder, 2008). In October 2008, the CMS discontinued payments for additional costs associated with pressure ulcers acquired during hospitalization, leading to significant financial implications for acute care facilities and increased interest in pressure ulcer prevention programs (CMS, 2008). Repositioning patients approximately every two hours is a foundational element in preventing pressure ulcers (Ayello & Lyder, 2007). The purpose of this investigation was to determine if there is a difference in documented patient care staff repositioning behaviors when a turn clock is used to cue patient repositioning. Data collected can assist nursing leadership in improving pressure ulcer prevention, thus increasing patient safety. This investigation utilized a convenience sample of patient care staff (N = 38) on the oncology unit of a midwestern regional medical facility. Patient care staff assigned to patients with a pressure ulcer risk assessment score on the Braden Scale of 18 or less were included in the investigation. A power analysis provided an estimated result of 392. For both the pre-intervention phase (not cueing with a turn clock) and the intervention phase (cueing with a turn clock) of the investigation, 392 patient care staff documentations of “every two hour” patient repositions were assessed (N = 784). The data were obtained from the facility’s electronic medical record repositioning documentation. The research question was, “In the acute care setting, is there a statistically significant difference between documented patient care staff repositioning behaviors cued with a turn clock (post-intervention) and those not cued with a turn clock (preintervention)?” This question included several comparison analyses. Pre-intervention and post-intervention repositioning documentation for positioning intervals were compared. Pre-intervention data (n = 392) revealed 289 repositions occurring approximately every two hours while 103 repositions did not occur approximately every two hours. Post-intervention data (n = 392) results showed an increase to 318 repositions occurring approximately every two hours with a decrease to 74 repositions that did not occur approximately every two hours. A chi-square analysis was computed to determine if there was a difference between the number of times that staff documented repositions approximately every two hours. Findings indicated that staff cued with a turn clock were significantly more likely to reposition their patients approximately every two hours than staff who were not cued with a turn clock, X2 (1, N = 784) = 6.14, p &lt; .05. A post-hoc analysis was completed on the post-intervention data to compare the documented positions with the positions specified on the turn clock-repositioning schedule. Only the documented intervals that included a lateral or back reposition in the bed were included (N = 313). A sign test analysis was computed to determine whether the number of correctly documented positions (n = 169) was significantly greater than the number of incorrectly documented positions (n = 144) and if the number of correctly documented positions was greater than chance. Findings indicated that the correctly documented positions were not significantly greater than the incorrectly documented positions (p = .0874), thus the probability of a correctly documented position were no greater than chance based on the specified .05 significance level. Results of this investigation have shown that use of the turn clock as a cue for patient repositioning significantly increased documented staff repositioning behaviors at approximately every two-hour intervals. However, the turn clock was not shown to be an effective means for ensuring repositions to specified positions.