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.

[fuzzywuzzy, CNA]

I'd be interested to see the data on q2. Our hospital's rehab unit does stretch out the times to q4 and even some I think are left overnight. And this is policy, not just laziness, I'm sure they got data to support it.

My little sister would be considered "high risk" but at home, my mom lets her sleep through the night. She's NEVER gotten a bedsore except for one at the hospital, and I almost wonder if it was from the dragging when pulling her up in the bed during the turns q2.

I hate turning folks q2 at night, not because I'm lazy, but want the poor folks to be able to sleep through the night. What is it about "2 hours" that makes it the magic number?

I get uncomfortable just being in one spot for a half hour. Anyway if you have to change someone q2h you may as well turn them. For the people who have foleys, I guess that's what those air mattresses that inflate in different spots are for. When I worked second shift I would put people who didn't wet much to bed with pillows under both sides. 2 hours later, one side would get pulled out, and 2 hours after that, the other side would get pulled. It was a lot less likely to wake them up then actually rolling them with with the pad and shoving a pillow under there, but it still shifted their weight.

[TigerGalLE, BSN, RN]

I get uncomfortable just being in one spot for a half hour. Anyway if you have to change someone q2h you may as well turn them. For the people who have foleys, I guess that's what those air mattresses that inflate in different spots are for. When I worked second shift I would put people who didn't wet much to bed with pillows under both sides. 2 hours later, one side would get pulled out, and 2 hours after that, the other side would get pulled. It was a lot less likely to wake them up then actually rolling them with with the pad and shoving a pillow under there, but it still shifted their weight.

I do agree with some of this. As in when a patient is on their side and sleeping really well.. I will go and remove the pillows so they shift back supine. It usually doesn't wake the patient and their weight is shifted. That gives them a 4 hour stretch of sleep. Then 2 hours later we go on the other side.

[kcochrane]

University of Texas School of Nursing at Houston | Center on Aging |turn_overview

Looks like I was wrong..they are looking at every 3 hours to turn.

Schnelle and colleagues (Schnelle, Ouslander, Simmons, Alessi, & Gravel, 1993) called for studies that individualize resident care to allow repositioning and other care while promoting sleep, suggesting awakening residents only every 3 hours. It is important to note that according to current practice, for every nursing facility resident requiring repositioning every two hours, 12 repositioning episodes should occur per day, 365 days a year, or 4380 times per year. At 5 minutes of Certified Nursing Assistant (CNA) time per repositioning episode a total of 21,900 minutes or 365 hours or 9.15 weeks per year are required for this one intervention. When repositioning is done, it often requires two CNAs, which means that 8,780 times per year per resident, or 730 hours or 18.3 weeks per year is required per resident. Repositioning exposes a CNA to risk of injury and a resident at risk for decreased quality of life when they are not permitted to sleep enough to feel rested. Clearly identifying those residents at risk for pressure ulcers, estimating the degree of mobility, controlling pressure exposure from the support surface and determining the optimal frequency of repositioning would revolutionize care and permit more time for activities that enhance quality of life (eg. ambulating, feeding, toileting, and more). Determining the appropriate frequency of repositioning is important to keep residents safe, improve quality of life and make judicious use of staffing time in the health care industry.

[kids]

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

Simply documenting the refusal isn't enough (especially in LTC/SNF).

It also needs to be documented that the patient was educated on the risks of immobility and the benefits of repositioning every time they refuse. Any pattern of refusal needs to be addressed in the care plan and other disciplines involved.

[BackfromRetirement]

There are times when I require a pt be turned every hour. The skin condition and tissue perfusion have to be taken into account individually in some cases.

[Scarlette Wings]

i understand the confusion. you are doing what is right and giving quality care. it is sad that other health care givers choose to ignore such a basic standard of care. unless it is different in your state, turning a patient every two hours does not require a doctors order, it is a nursing standard of care. (unless of course for some reason turning were contraindicated)

nurses do not need an order to bathe a patient, assist feed them,or perform mouth care. some things are just basics. let me encourage you to continue to do what is right, set the example, and give the kind of care you would want your parent or child to receive.