Turning babies Every 2 hours?

Specialties NICU

Published

Specializes in NICU.

I work at a Level 4 NICU, in a pediatric hospital. Right now, skin care is a hot topic, for the whole hospital. Whenever we have a new initiative, we are expected to follow suit, whether or not it really applies to our unit.

Part of the new criteria, is that we turn our ALL patients every 2 hours! To me this seems excessive. Some of our babies are minimal stimulation and we only assess every 6 hours. Turning is one of the more stressful parts of the assessment and our very sensitive patients can take an hour or longer for vital signs to stabilize/return to baseline.

Our patients that feed every 3 hours, we are supposed to go in and bother them an hour before they are due to assess, just to turn them! Good luck getting them to go back to sleep, especially being so close to feeding time. So much for cluster care.

Our fresh micro preemie, that we usually kept midline and supine for 72 hours to prevent IVH, we now have to turn.

Personally, I rarely see pressure sores. Usually it is when the babies come from other hospitals, or a baby has been laying on their IV hub or a cap from labs, (which for those things, the solution is simple- be vigilant about what your patient is laying on). I feel like we are making an issue out of something that is not really and issue.

When we asked about NICU being expect from this change, we were told that because we are a critical care unit, our patients are at risk for skin break down, so we have to do what ICUs do. Is there any evidence based practice that is NICU specific, for turning their patients this often?

I was just wondering what other hospitals are doing. Has anyone else seen new skin care policies come into play? How often do you routinely turn your patients? Is your unit expected to follow whatever changes the other units make?

This is insanity, I would hope that the senior nursing leaders in your unit would block this from being implemented as it makes no sense for your population. Your the only unit in the hospital that deals with developing brains that should still be developing in utero.

If skin care is a hot topic in the hospital the nursing leadership from NICU should he sharing how you will make skin care a priority, but in a relevant way for your population.

Here are some possible things to suggest to hospital leadership if not already written into policies:

1. Appropriate use of skin cleansers for procedures, ie. Having a policy for what solutions you use based on gestational age (alcohol vs chlorahexadine vs betadine)

2. Use of appropriate taping and minimising direct contact with skin, ie. Tapes that are gentle on skin and duoderm

3. Reinforcing the importance of skin assessment as part of daily head to toes (especially checking backs and in ceases)

4. Vigilant assessment for skin breakdown in relation to CPAP equipment and rotating of mask and prong

5. Diaper dermatitis management

Lastly, discuss which patients may be appropriate in your unit for frequent turning-older chronic babies who can't move much on there own perhaps? Also maybe bring in the use of Z-flo mattresses and discuss developmental positioning used in the unit.

Specializes in NICU.

That is crazy. We handle out patients Q3h maximum and even on older babies I often leave them for 6h if theyre sleeping. A micro prem? theres no way I'm moving them any more often than I need to. This is disruptive to their brain development. is stressful for them and can lead to a whole slew of long term issues. I hope your leadership will change this practice ASAP.

Specializes in NICU.

We only q2 hr repositioning for babies on hypothermia blanket. Everyone else is q4 or even 6 hr if unslable. Micropreemies are still supine midline, but we can do a bit of a logroll tilt for their head and bodies.

I don't know why, but NICU patients just don't seem to get pressure sores. I've only seen one, and that was on the back of the scalp of a poor little hydrops preemie with severe, severe edema. We just couldn't position him any other way but supine/midline and still oxygenate. :-(

Specializes in NICU.

This is a matter of the NICU is its own little world and the hospital doesn't believe that and is trying to make to make a circle fit into a square. Hopefully you and your colleagues can talk to your educator and manager- and better yet, get the docs and NPs involved to advocate to not be forced to do this. I wish you luck for the patients' sake.

It seems like it would be more disturbing and upsetting for a very sick baby.

That is crazy, against evidence based practice for the NICU setting, and I would not participate in it.

Our hospital does not expect NICU/PICU to follow positioning recommendations that are based on the adult population. I am actually mad for you. The only time I've seen our babies get pressure ulcers is from CPAP gear, but we implemented a new skincare policy (hydrocolloid barrier and skin checks q shift) and the problem went away.

The hospitals do this for same reason they do it with adults. Medicare/medicaid do not reimburse for hospital-acquired skin breakdown (along with an ever-growing list of things.

When faced with financial loss hospitals take things very seriously. I certainly did not wake up alert and oriented adults every two hours!

Specializes in NICU.

We already do all of these things, except we are trying to switch from duoderm to Pink skin care products, although we keep getting educated on them, but never have them on stock.

We use the Tortoise mattresses, instead of Z-Flo, but they seem like they are the same thing.

We used to have issue with SiPAP masks, years ago, but our rotation policy has seem to fix that.

We really don't seem to have much of an issue with pressure ulcers.

We are also now required to have some kind of intervention to skin, with every assessment, since our patients are ICU patients and are deemed "at risk." These interventions include putting some kind of moisturizer and/or moisture barrier to their skin. Medline is the favored product here. In the past we were discouraged from putting unneeded chemicals on our preemies, because they absorbs so much more through their skin, than older patients.

Specializes in NICU.
This is a matter of the NICU is its own little world and the hospital doesn't believe that and is trying to make to make a circle fit into a square. Hopefully you and your colleagues can talk to your educator and manager- and better yet, get the docs and NPs involved to advocate to not be forced to do this. I wish you luck for the patients' sake.

Trying to get the docs and NNPs involved is a great idea! Thanks! Unfortunately, our management is just going along with it, but our manager is not from an NICU background.

Specializes in NICU.
This is insanity, I would hope that the senior nursing leaders in your unit would block this from being implemented as it makes no sense for your population. Your the only unit in the hospital that deals with developing brains that should still be developing in utero.

If skin care is a hot topic in the hospital the nursing leadership from NICU should he sharing how you will make skin care a priority, but in a relevant way for your population.

Here are some possible things to suggest to hospital leadership if not already written into policies:

1. Appropriate use of skin cleansers for procedures, ie. Having a policy for what solutions you use based on gestational age (alcohol vs chlorahexadine vs betadine)

2. Use of appropriate taping and minimising direct contact with skin, ie. Tapes that are gentle on skin and duoderm

3. Reinforcing the importance of skin assessment as part of daily head to toes (especially checking backs and in ceases)

4. Vigilant assessment for skin breakdown in relation to CPAP equipment and rotating of mask and prong

5. Diaper dermatitis management

Lastly, discuss which patients may be appropriate in your unit for frequent turning-older chronic babies who can't move much on there own perhaps? Also maybe bring in the use of Z-flo mattresses and discuss developmental positioning used in the unit.

We already do all of these things, except we are trying to switch from duoderm to Pink skin care products, although we keep getting educated on them, but never have them on stock.

We use the Tortoise mattresses, instead of Z-Flo, but they seem like they are the same thing.

We used to have issue with SiPAP masks, years ago, but our rotation policy has seem to fix that.

We really don't seem to have much of an issue with pressure ulcers.

We are also now required to have some kind of intervention to skin, with every assessment, since our patients are ICU patients and are deemed "at risk." These interventions include putting some kind of moisturizer and/or moisture barrier to their skin. Medline is the favored product here. In the past we were discouraged from putting unneeded chemicals on our preemies, because they absorbs so much more through their skin, than older patients.

Specializes in NICU.
but our manager is not from an NICU background.

That could be one of your problems

+ Add a Comment