(1234) A Quality Improvement Project: Turning the Clinically Unstable Patient

Introduction: During the COVID-19 pandemic on a 30-bed Medical Intensive Care Unit at a large teaching hospital critically ill COVID patients were experiencing catastrophic hospital-acquired pressure injuries. It was observed that many of these patients were described as “too [hemodynamically] unstable to turn” by the RN's, resulting in patients remaining in static positions for several hours or days at a time. The definition and perception of hemodynamic instability had huge variation amongst staff, along with comfort levels associated with hemodynamic variability.

Methods: A QI project was implemented to create a turn trial to be completed at the beginning of each shift, using an algorithm loosely based on an existing guideline. MAP and SpO2 were the determining data for the algorithim. A 20-question survey was sent to staff (n= 164) to ascertain comfort levels with hemodynamic values, shift-change educational briefs given, and reference badge cards provided. A follow-up survey was disseminated to ascertain learning achieved and perceptions of the new turn trials. Upon implementation, there was a decrease in COVID-19 patients in the unit. The intervention changed to RN knowledge and perception post-educational intervention and algorithm rollout for all hemodynamically unstable patients.

Results: Results of the follow-up survey revealed an increase in knowledge and less variation in acceptable thresholds for turning. Nurses reported feeling comfortable in adapting turn trials for future unstable patients as an easily integrated intervention into daily work-flow.

Conclusions: There was significant increase in understanding of hemodynamics and changes to perception in instability. The positive response allowed nursing leadership to introduce the turn-trial and algorithm as a pilot program with long-term analyses of results and integrate results of the turn trials into the electronic health record flowsheet for the MICU.
The implications of the turn trial may extend to other ill effects of gravitational equilibrium, but more data is needed. Less variation in perception and knowledge amongst nurses and use of the algorithm have potential to drastically impact HAPI prevention.
The author has no disclosures to report.