Turn every two hours

[Alnitak7]

In my first few years of working, one of the first things I encountered were patients who were comatose,

or comletely helpless and there was a rule that they had to be turned every two hours.

I remember one co-worker who would always ask me, "Have you turned L?" I always answered, "Yes."

Later on, I worked in places where they did not seem concerned about the ones who could not move.

Sometimes, they were left for as much as five hours. One time, I even ran into some debate about

a comatose patient who I thougnt should be turned. She was on my group, I went in to change and turn her

and someone who was not a supervisor immediately stopped me and she was adament about it.

Turning them at regular times seemed almost unheard of.

I also noticed when I first worked in this place, the charge nurse seemed a little surprised and

indifferent when I told her, "I'm going to turn Hazel." She just seemed to shrug.

Some authorities think they should be turned every four hours. They talk about them getting,

"settled in." In one specific nursing home I worked in, it seemed to confuse the others when I would go in

to turn mine and I felt like an odd ball.

I don't know how they can be so indifferent this way and they don't get in trouble for it.

I would ask them about it but did not get much of an answer. The DoN knew that this was going on. I heard some excuse about not wasting diapers, but this is not valid.

[CNL2B]

Don't know what care setting you work in. In most hospital settings, a pressure ulcer risk assessment is done and if the patient scores "at risk" to any degree and is bedridden, they get turned q2h per our nursing skin care protocol (this is one of multiple interventions that is put into place.)

I think it's typically the standard of care to turn comatose patients q2, unless they are comfort cares only and the family doesn't want them moved, or some other extenuating circumstance bars you from turning them.

No, you're not crazy. I learned this in nursing school, I think probably most did as well. It shouldn't come as a shock to anybody that you want to do this.

[fungez]

Not turning a comatose patient is horrible nursing care. I've never encountered it in my career.

[LouisVRN, RN]

My hospital actually considered playing "Under pressure" every two hours to remind nurses to turn their patients, even without that it is still an expectation and is considered an incident if its not done and documented, or documented pt refuses every two hours.

[rosey2007cna]

I took my CNA class in 2008 and they told me to turn my residents at least every two hours. That was the case for almost all the places that I worked at. Then I worked at one place that told me to turn my residents every three hours and even had the nerve to mark me wrong on one of my tests for saying that they need to be turned every two hours . I could not believe that they think it is okay for a resident to sit in the same spot for three hours.

[caliotter3]

I was immobile myself one time and found that I experienced painful sensations before even two hours. It certainly brought home the "turn every two hours" teaching.

[qt_rn]

People give me a crazy look at my workplace too when I ask for a hand turning a pt q2...which is weird because on another floor in the same hospital my preceptor was all over the q2 repositioning. A lot of nurses tell me at night time to let them sleep because we are a rehab floor and they need to sleep to function well with pt/ot or that they are a poor sleeper and if you wake them up while turning them they will never get back to sleep...then there is the one who refuses to be turned until he starts getting a coccyx sore, will allow a pillow to be placed under his hip to remove pressure and once the sore disappears he again refuses to have that pillow there...

I try my best to turn the dependent pts q2, although we do have quite a few pts that would prefer to sleep no matter how much information you provide about pressure ulcers. I feel like I just don't know what to do sometimes! To turn or not to turn! What if a pt can only breath comfortably in a certain position, or just prefers not to be repositioned overnight? Do you just document and leave it at that or do you continue to encourage or just do it?

[qt_rn]

My hospital actually considered playing "Under pressure" every two hours to remind nurses to turn their patients, even without that it is still an expectation and is considered an incident if its not done and documented, or documented pt refuses every two hours.

I like that idea!! A good reminder, 2 hours can fly by so fast without realizing it! Then there are lazy ones who just don't want to be bothered with it...to those I try to offer a hand with turning their patient hoping that by mentioning it they will get the hint...

[kcochrane]

They are in the process of doing a study to show that every 4 hours does not raise the risk anymore than every 2 hours. Of course you know if we determine every 4 hours is ok...it will get stretched to every 6-8. Anyways, my old facility was included in the study, so we should see some results at some point.

But this study was done on patients that weren't high risk for breakdown.

[CoffeeRTC, BSN, RN]

Please, Please, Please keep doing what you are doing. I can't tell you how many patients we get from the hospital with bed sores. Preventable bed sores. Yes, sometimes even with the best care, you cannot prevent them from happening, but being very simple about it..clean em, feed em and move em.

[TigerGalLE, BSN, RN]

At my hospital we have a turn team. They are actually an extension from our transport team. Each transporter is assigned a unit/floor. Every 2 hours they go around and offer their assistance to turn patients. I love this. Sometimes I don't need their help, sometimes I've just turned my patient, and sometimes I'm so thankful they are there to remind me 2 hours is up. Sometimes when you are busy 2 hours flies by so fast and you don't even realize it is time to turn.

The turn team has tremendously decreased our number of hospital acquired pressure injuries at my hospital.

It is also nice to have that person there to help you instead of having to go track down your busy coworker.

Edit: Turning every 2 hours is the only way to prevent pressure injuries. In addition to moisture management and nutritional support. You can give nutrition and they can have a foley all day long, but if you don't turn... pressure injuries will occur.

Pressure injuries = bad nursing care

With the only exception being a patient who is too sick to turn. And you will only find that in your ICU setting. This patient should still be on a rotator bed with a good mattress.

If a patient refuses to turn.... document document document. Document every 2 hours that you attempted to turn and patient refused.

[fuzzywuzzy, CNA]

Where I work a lot of people have turn schedules ie "right side till 9, left side till 11, OOB till 1..." I guess so that anyone can check to make sure the person is actually getting turned. I turn everybody whether they are on a schedule or not though.