Time to Turn Patient Education Brochure

Intervention Title:
Reducing Bedsores by Creating Awareness of When to Turn Patients – University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pa.

Increase the frequency and consistency with which patients are turned.

Staff posted “Time to Turn” visual indicator signage on patient doors.

Staff turned and positioned patients consistently every two hours.

University of Pittsburgh Medical Center
200 Lothrop St.
Pittsburgh, PA 15213-2582
P: (412) 647-8762

From the experts:
“Something as simple as a magnet has enabled us to improve safety by establishing a standardized indicator telling when patients need to be turned. Not only are patients being turned on a regular basis, but family members are learning how important it is to continue this care at home for their loved one.”

Lisa Vertacnik, M.S.N.
Unit Director, Magee-Women's Hospital of UPMC

University of Pittsburgh Medical Center is composed of 19 hospitals and a network of other care sites across western Pennsylvania and throughout the world.

Clinical areas affected:

  • All hospital units

Staff involved:

  • Nurses

The program was tested for six months and is currently being spread throughout the entire health system.

Mary Kay Wisniewski, M.T.
Improvement Specialist
Center for Quality Improvement and Innovation
P: (412) 802-8066

Innovation implementation:
On a medical unit filled with patients with complex conditions and busy staff, it became apparent that taking time to turn patients needed to be a much higher priority. Many of the patients were at risk for skin breakdown and respiratory compromise when not frequently turned. Additionally, caregivers were unsure about when to turn patients and adequately position them because it was not clear when a patient had last been turned.

To improve the frequency and consistency of turning patients, a visual indicator was developed that could easily and immediately be seen by all front-line staff. The initial visual included a magnet that was moved every two hours to indicate when the patient was last turned and provide guidance on which direction to turn the patient.

In addition to establishing a standard for caregivers, families also learned the importance of turning patients and can adapt this intervention for use at home.

Advice and lessons learned:

  1. Ask clinical staff for ideas. Clinical staff best understood the process and what would work.
  2. Make it a do-it-at-home intervention. When developing a tool, make sure it's something a family can use when the patient goes home.

Cost/benefit estimate:
Staff have maintained zero tolerance for pressure ulcers and skin breakdown. Benefits also include a decreased risk of nosocomial pneumonia.