Strive Towards CALNOC Excellence: Adopting Innovation to Improve Bedside Nursing Care


Lead Presenter

Supporting Presenters

Mary O’Neill, RN, BSN, CWON, Kaiser Permanente, Redwood City, CA
Nora Tam, BPA, Kaiser Permanente, Redwood City, CA

Presented At


Purpose: Embodying CALNOC excellence in patient care and nursing practice, the facility’s "Heroes" committee sought to improve on-time delivery of patient repositioning in order to improve facility's pressure ulcer benchmarks.

Background and Significance: Besides preventing pressure ulcers, manual turning has been shown to reduce incidence of nosocomial pneumonia, reduce length of stay, number of rental bed days, improve comfort and circulatory response. Although two-hourly turning is considered standard of care for mobility-impaired patients since Florence Nightingale, studies show that compliance to turn protocols varies from 38% to 66%.

Methods: Patient-wearable, wireless technology measuring real-time patient orientation was deployed on two 24-bed medical/oncology and telemetry units where a two-hour turn protocol is used for at-risk patients. The system measures real-time patient orientation and provides visual cues to reposition patients when period of immobility exceeds prescribed turn interval and automatically documents patient turns.

Results: 138 patients were monitored over a 30 day period for 5560 hours. Turn compliance was calculated as the sum of total time in compliance per patient divided by the sum of total time monitored per patient. Average turn compliance was 93% and ranged from 90.1% to 96.8% which exceed literature benchmarks. Because turn alerts generated by the system were visible to all unit staff, the staff felt that the technology helped promote a team work culture for patient care.

Conclusion: Using innovative technology approach to solve a traditional nursing challenge helps improve on-time care delivery, documentation and teamwork in a busy medical/surgical environment.

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