On behalf of the institution University of Miami Health System

After reviewing evidence-based research and peer-based literature, Gisselle Castaneda, BSN, RN, an intensive care unit (ICU) nurse at the UHealth – University of Miami Health System, sought out to improve hospital-acquired pressure injury (HAPI) outcomes for the most critically ill patients. Motivated by her learnings, Castaneda recognized the impact of implementing a turning team as an effective method of reducing HAPIs, especially for ICU patients and those on vasopressors, who are more vulnerable to pressure injuries and require frequent repositioning. Drawing from the literature and aligning it with her patients’ needs, she translated research into action, demonstrating how evidence-based strategies can lead to improved, measurable health outcomes.

While nurses are required to turn patients at least every two hours, ICU nurses are focused on emergent needs such as resuscitation and medication management, relying on informal support to reposition their patients.

In light of current practice and the published research, Castaneda proposed the creation of the “UTurn Team.” Her idea was simple: each ICU nurse would sign up for one time slot per shift to turn all the patients with a Braden scale score of 18 or less. The frequency of turning and repositioning is generally uniform across clinical settings, with most clinical guidelines recommending a substantial change in a patient’s position according to their health status. By standardizing the turning process, UHealth patients benefit from minimized pressure on the targeted skin and enhanced blood perfusion in the affected areas. With support from their colleagues, nurses can successfully meet the two-hour patient turning requirement.

The UTurn Team was initiated in March 2023, and Castenda trained the nurses in all four ICUs, reinforcing the importance of standardized patient-turning procedures. The nurse manager for each unit purchased a marking board for the unit secretary to identify the nurses responsible for turning. In addition, a new full-time position was created for a certified nursing assistant to support this project. A sign-up sheet was developed so nurses could choose a time slot best suited to their needs. The unit secretary reminded the nurses when it was their time to participate. If a nurse became busy, they could switch with another colleague or request assistance from the charge nurse.

Castaneda reports that forming this taskforce has improved collaboration between nursing staff and the workflow in her unit, and this concept has since expanded to include all inpatient units. “The UTurn Team embodies the collaborative spirit of our clinical nurses to promote quality, safe patient care,” Casteneda said. “The goal of this system is to prevent gaps in turning patients by systematically approaching turns across the unit and build teamwork.”

The UTurn Team concept was embraced, not only by Castaneda’s unit management, but also by her fellow nurses who appreciated the idea of having their eligible patients turned every two hours while reducing the burden on nursing staff. The metrics showed success with this project, and the ICUs experienced a decrease in their HAPI rate after this task force was implemented.

Castaneda is proud of what she has achieved. “This is just one example of how clinical nurses are empowered to learn, collaborate and support our patients and our practice,” Castaneda continued. “The initiative is beneficial for patients, and our nurses have expressed positive feedback on the system.”

Ellie Smith is Chief Nursing Officer, University of Miami Health System.