Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Vanessa Loyd, College of Nursing


Vanessa Loyd, DNP/PhD/RN

Jennifer Vines, DNP/RN

Jessica Donnelly, MHA/BSN/RN


Problem: Hospital-Acquired Pressure Injuries (HAPIs) are the only quality metric increasing in incidence and are preventable. HAPIs are wounds to bony prominences during a hospitalization and can increase hospital costs, morbidity, and mortality. HAPIs could be prevented through interventions, including repositioning patients every 2 hours and using a turn clock method. The aim of this quality improvement (QI) pilot project was to decrease HAPI incidence.

Methods: A turn clock method was implemented on a general medicine floor at a mid-sized, suburban medical center utilizing a descriptive retrospective observational design. Data was collected for the pre-intervention timeframe from June through August 2021 and the post-intervention timeframe from October through December 2021. A retrospective medical record review was used to observe HAPI incidence, turn clock usage, 2 hour turning compliance, and demographic variables.

Results: HAPI incidence decreased post-intervention to 0.271% from the pre-intervention of 0.619%. In pre-and post- incidences, a two-proportions z-test revealed the differences were not statistically significant (p=.299). The results of a reduction of HAPI occurrences were clinically significant. Out of the 46 individuals in the sample, two individuals were turned every two hours or 12 times in 24 hours. However, the average number of turns in the patients who had a turn clock was slightly higher than those without.

Implication to practice: Ongoing QI analysis could be performed. Usage of preventative interventions, such as turn teams and turn clocks, may well decrease incidences of HAPIs. Explore the possibility of creating a role designated to ensure compliance.

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