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Diebel,M.FinalPlanA.NURS711

Proposal for Turn Teams

A. Clearly explain the quality improvement project What exactly are you planning to do?
The objective for this project is to create a culture of patient safety reducing the risks of
patients obtaining pressure ulcers during their stay at the hospital. My activities will include
writing the process for establishing patient turning schedules, and implementing turn teams as
preventative measures towards improved quality of patient care. This particular project serves
as a dual purpose, improving quality and safety for patients and providing substantial cost
savings resulting from the reduction of extended patient stays.
A large part of this project will include proper patient assessment to determine the risks
of hospital obtained pressure ulcers. This data can be used as measurable indicators for
determining the frequency for turning each patient, making the implementation of turn teams
more effective.
B. Provide evidence based support that establishes a need for this project.
According to Hagisawa and Ferguson-Pell (2007), Nightingale documented in 1860 and
1882 the need to manage the ownership position to prevent and dress bed-sores. At this time
Nightingale did not document a time interval for turning a patient in order to prevent bed-sores,
or now known as pressure ulcers. She was clear about the seriousness in preventative care
stating if a patient was unable to move on their own, they could die of bed-sores.
Preventing pressure ulcers continues to be a concern in the healthcare industry. There are
four stages starting with one being the least amount of skin break down, to stage II consists of
blisters or open sores on the surface of the skin. Stage III includes the result of extended
pressure causing an open sore. Lastly, stage IV which has the highest severity causing additional
risk factors such as infection affecting multiple layers of tissue. Sullivan (2013), stated despite

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the awareness on pressure ulcer prevention the number of incidences increased 80% between
1995 and 2008. It was estimated in 2008 that 2.5 million people would obtain hospital related
pressure ulcers in the United States, with related complications killing 60,000 people (Sullivan,
2013). These rates are predicted to continually increase as the baby boomers are approaching
elderly ages, as well as increased numbers of people being obese and diabetic. The costs to treat
pressure ulcers in 2008 were estimated at eleven billion annually (Sullivan, 2013). This
estimation did not include prevention costs.
Based on a study performed by Hobbs (2004), turn teams have been acknowledged as a
method for reducing stage II pressure ulcers by 2.3% per month, as well as reduce the average
hospital stay by 0.95 days. The nosocomial infections also were reduced from 4.2 cases per
month to 1.5 cases contributing to a decline in nosocomial pneumonia. Additional areas of
improvement during this study included a measurement of nursing staff musculoskeletal injuries
reducing from 1.07 to 0.75.
Patient assessment for pressure ulcers is an important aspect of monitoring risk and
determining the preventative measures needed. The use of the Braden scale allows scoring of the
pressure ulcer with a score range from 6-23, with the low score as being the highest risk for
developing a pressure ulcer (Still, M. et al, 2013). Still et al, (2013) performed a study on the
effects of preventative measures such as the implementation of turn teams. The overall study
produced results of significant reduction in patients obtaining pressure ulcers (p. 373). The
sample size this study used was based on one facility totaling 507 patients. The turn teams
turned hemodynamically stable patients every two hours on a total of 229 patients of the 507.
The conclusion of this study identified turn teams almost eliminated stage 1 and 2
pressure ulcers when turning patients every two hours (Still, M. et al, 2013).

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Diebel,M.FinalPlanA.NURS711
From a financial standpoint, there is a financial need for supporting pressure ulcer
preventative measures. A major financial adjustment was made in the health care industry since
2008. Medicare is no longer reimbursing hospital acquired pressure ulcers. This reimbursement
reduction resulted in approximately $70,000 $100,000 per patient (Voz, Williams & Wilson,
2011). Hospitals are now having to pay for treatments caused by potentially preventative
injuries acquired during a hospital stay.
C. Where will this project take place? Describe the environment/facility/unit etc.
My current understanding on where this project will take place is Detroit Receiving
Hospital (DRH) the environment is in a hospital setting, but at this time without the affiliation
agreement in place, I am unaware of the specific units or team members that will be involved.
D. Who else will be involved in this project? What will their roles be?
(See Appendix A for agreements)
Detroit Medical Center (DMC)
Toni Grant, DNP, RN, ACNS-BC, ACNP-BC
Corporate Director Practice Environment
Dr. Toni Grant has agreed to be my mentor for this project, providing the framework and
guiding the outcome expectations. Dr. Grant indicated her specialization entails identifying
areas of need for operational improvements, proposing quality and safety program
improvements, developing strategies for both new and existing programs. She also monitors
compliance with hospital accreditations as well as legal regulatory requirements according to the
State rules and regulations. Dr. Grant is responsible for creating solutions to complex issues in
patient care, customer service, and physician relations for projects with a corporate wide impact
(Personal communication, March 27, 2015).

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Diebel,M.FinalPlanA.NURS711
As for whether or not the DRH staff members will be involved with this project, it is
currently unknown. Due to the affiliation agreement not being in place, this information has not
been provided. Reassurance has been provided that there are groups I will be working with.

E. Complete an assessment of the QSEN graduate level competencies.

The health care profession is transforming towards integrating the initiatives of the
Quality and Safety Education for Nurses (QSEN) through specific objectives of specified
Knowledge, Skill and Attitude (Sherwood & Barnsteiner, 2012). Health care is one of the most
complex businesses in the world, making this transition not an easy task. The health care culture
needs to improve and include changes in everyday practice to support a learning organization.
The nursing role itself is becoming more proactive through QSEN and Knowledge, Skill
and Attitude (KSA) methods. Nurses are the primary force for incorporating evidence-based
materials for improved healthcare outcomes. Nurses are providing best practices with a focus on
high-quality care that will impact the quality and safety culture on the work environment
(Sherwood & Barnsteiner, 2012). With these initiatives, nurses are becoming increasingly
empowered, creating improved health care outcomes and increased job satisfaction (Sherwood &
Barnsteiner, 2012).
QSEN Competencies
Teamwork &
Collaboration

KSA's
Knowledge

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Collaboration is needed to build a positive relationship between
the leader and followers. This is best supported by Batcheller
(2012), stating, A balance of power between leaders and
followers creates a culture of trust and openness (p. 22).
Training sessions would be provided, team building and review
body mechanics. The nursing staff would have specific
knowledge about the client, allowing them to know them
better and apply their knowledge through maintaining the
environmental needs for turning every two hours. A nurse is
responsible for providing an environment conducive to the
needs of a patients healing process (Selanders, 1998). Teaching
the staff to identify ways of improving current processes or
methods and promoting teamwork for problem solving turn
teams would be a great way to establish cohesion in the
department.
Quality Improvement

Knowledge
As nurses support the proven interventions through evidencebased programs the quality of health care will improve and
decrease skin break down and pressure ulcers.
Skills
Building off of evidence-based programs will contribute to
improved quality of health care and drive new approaches to
improved health in our population (Sherwood & Barnsteiner,
2012).
Attitude
Quality and safety is important aspect of nursing for
maximizing patients outcomes. The overall initiatives toward
quality and safety compliment the roles nurse. Nurses have a
direct effect on influencing new policies and implementing
methods for including quality and safety as priority in the health
care outcomes (Sherwood & Barnsteiner, 2012). The lean

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methodology and thought process would influence educating
the nursing staff through a coordination of nursing care with
other job tasks and integrating them to provide the most
efficient means of care for the patient (ANA, 2009).

F. Complete an assessment of the ANA Scope & Standards of Practice for your specialty
role.
1)

American Nurse Association [ANA] (2009) Standard 9: Professional Practice Evaluation:

This standard includes a self-assessment of rules, standards, regulations, and guidelines to ensure
a high level of professionalism in practice. Using this standard will allow me to learn how
administrators assess the unit for effectiveness. Learning how staff members are utilizing there
time and the guidelines they need to follow. It is also important for current administrators to step
back from time to time to evaluate their own nursing practice for continuous improvement.
Aligning nursing practice with the standards and guidelines will drive the bases for continuous
improvement for this project.

2)

American Nurse Association [ANA] (2009) Standard 10: Collegiality: The nurse

administrator has a large part in developing staff members in professional development.

Measurement criteria use is:
The nurse administrator shares knowledge and skills with peers and colleges as
evidenced by such activities as care conferences or presentations at formal or informal
meetings; establishes an environment that is conductive to the education of healthcare
professionals; and participates on multi-professional teams that contribute to role

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development and directly or indirectly, advance nursing practice and health services.
(American Nursing Association, 2009, p. 38)
This administration standard is important for supporting individual learning and
providing the appropriate environment for turn teams to become effective. Not only will this
experience provide a learning opportunity for myself, educating staff members about the need for
change and the reasons behind implementing turn teams will greatly benefit the effectiveness of
implementation for this change.

3)

American Nurse Association [ANA] (2009) Standard 11: Collaboration: This standard

includes the interaction required for the nurse administrator to work with all the stakeholders,
leaders, staff members and other internal support personal. The nurse administrator would
collaborate with team members by providing a written plan to meet the intended goals towards
quality care and service. This standard would help me individually with communicating the plan
to stakeholders as an important part of the change process. This communication process will
create an awareness as stakeholders learn more about the benefits of added turn teams, and
accept the need for change.
G. Complete an RCA with key stakeholders and/or peers with an understanding of the
issue you will be addressing.
I will be working with a committee and possibly Dr. Grant to collaborate on the Root
Cause Analysis (RCA). I have developed a hypothetical RCA for this project plan, and will
finalize it once the affiliation agreement is official. The RCA is available for viewing in
Appendix C.
H. Identify a Change and Leadership theory you will employ during project
implementation and support.

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The change theory chosen as a tool for resolving turn teams is Lewins Theory of
Planned Change (TPC) consists of three phases for working through the change process. This
theory is broken down into three stages known as unfreezing, moving or transitioning, and
refreezing (Lewin, 2011). These three processes will be utilized to implement the change in turn
teams are unfreezing, moving or transitioning, and refreezing.
The issue of irregular cycles on turning patients every two hours, many not be consistent
from one hospital floor to another. Leading to skin break down can result in a pressure ulcer
causing an additional need for staff to provide additional care for patient and increase costs
incurred by the organization. Change is a difficult process, Lewin (2011) explains change as
a dynamic balance of forces working in opposing directions. It is fairly clear professionals
in healthcare are having a difficult time focusing their energies on patient care when there are so
many internal and external stressors when practicing healthcare. Carpers patterns of knowing,
provides nursing care through empirics, esthetics, personal knowledge and moral knowledge to
effectively care for others (Carper, 1978). With the added daily stressors, long hours,
understaffed facilities, high expectations, perfectionism, and the relentless documentation, it
should not be a surprise if the staff experiences emotional reactions when a major change is
introduced.
Change
Utilizing Lewins Theory of Planned Change, the first step in the process of change is
establishing that a change is needed. Once management recognizes the need for change, they
will portray a sense of urgency for the change (Lewin, 2011). After this recognition a plan needs
to be put in place to determine the extent of the issues in order to formulate solutions to those
problems. An example of this is defining who is responsible for making the decisions during the

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change process (Credo Database, 2005). This organization could present, graphs calculating the
extent of the turn teams by measuring the data collected to show the areas of need to upper
management. This unfreezing step is critical in assessing the real problem and presenting it to
management (Lewin, 2011). Especially being part of a Complex Adaptive System (CAS) where
it is important to have the ability to adapt to change. These results for an adaptive environment
for change could change the entire organization and its structure (Clancy, Effken, and Pesut,
2008).
Transition
The second process of change is to transition from the data collected when a patient was
turned every two hours can formulating a plan of action and implementing the plan to reinforce
all patients who require turning every two hour are being turned. Some potential challenges
could be a resistance to change. Because this process is being written by a student outside of the
organization, it would need to be continuously reinforced by DMC management as they move
forward. Dealing with these resistance challenges, it will take coaching staff members on
methods to provide clear communication and overcome obstacles to maintain the path towards
the intended goal (Lewin, 2011). If this does not occur, it is likely for turn teams to continue
without resolution. Therefore, the importance of moving forward with recommendations from
the DMC organization is key to emphasize the importance of reaching the overall goal is to end
the intermittent in turning patients.
Freezing
The third process of Lewins Theory of Planned Change is refreezing. This process is
explained by Lewin (2011), Stabilizing the change so it becomes embedded into existing
systems such as culture, policies, and practices (p. 70). Once this is established, then the moral

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of the workforce is changed through having acceptance in the new day to day processes for
turning. This allows the organization to succeed in providing improved patient care contributing
to a better work environment with turn teams in place.
In conclusion, it was established there is a great need to address turn teams in the healthcare
industry. The effects of not turning patients every two hours have impacted the nursing staff,
patients, and the DMC. Through utilizing Lewins Theory of Planned Change for impimenting a
process to assess possible causes of skin break down and formulate a plan of action for
implement turn teams for turning patients every two hours. This process will improve the
outcomes of quality and safety for patients.
A transformational leader would not sit on the sidelines and accept a new policy knowing
it would have a negative impact on the information flow. A transformational leader values the
change to meet a common goal and motivates followers by meeting the needs to achieve it
(Marshall, 2011). Therefore, transformational leadership style would gain the respect of others
and create or inspire others to follow. This transformational leader provides the vision and
motivates others through guiding them t o see the opportunities for improvement, and motivate
them towards finding solutions for achieving the desired outcomes of turning patients every two
hours. The importance of how transformational leaders motivate their followers to commit to
and to realize performance outcomes that exceed their expectations (Conger, 1999).
Leadership Considerations
When implementing and managing change, it is important that the leadership style
supports the change initiative and cascades this commitment to change to their employees to
ensure a top down commitment to excellence with respect to the change process.
Transformational leadership focuses on the leaders ability to cast a vision and to inspire others

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to reach for that vision as well. From a transformational leadership approach, the leader inspires
the followers to work toward a desired outcome, not necessarily one developed by the followers.
Such an approach is different from the traditional complex systems generally associated with
leadership styles employed in the past. With transformational leadership, key employees do not
have as much influence on the definition of the goals, but are more involved with how to meet
these goals than the leader is. Hill (2002), describes a path for change within nursing education
programs as they seek to keep pace with the changes in healthcare. She discusses a framework
for change which requires a transformational leader as its pivotal force. One of the aspects of
this framework is the development of a vision for the future and producing a clear representation
of this vision so others within the program can work together toward the ultimate goals.
Transformational leadership is also explained by Doody & Doody (2012) for being an effective
method of leadership by providing leadership support and give recognition when it happens.
Transformational leadership maximizes the potential for every employee which
subsequently reduces the number of people on staff and subsequently lowering the costs
associated with doing business and maximizing the return on investment (ROI). As a result,
high-performing staff members and managers are empowered to do their jobs without having to
seek approval for each task they are performing which subsequently enhances employee
retention and overall satisfaction.
Change Implementation
It is important to note when adding a process such as turn teams to an already busy
schedule; it is inevitable some employees will resist the change process based on their already
heavy workload (Lewin, 2011). A change of this nature will require a significant effort by
management in order to achieve the appropriate level of buy-in from their employees and ensure

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their continued effort to maintain a sense of urgency and focus during implementation process.
The transformational leadership style embodies the necessary characteristics that both motivates
and inspires employees during the change process within the organization. A transformational
leader will gain the respect of their staff while at the same time creating and inspiring the vision
and momentum towards a positive sustained change initiative. The transformational leader
provides the necessary direction and daily goals to maintain the motivation of their employees.
Transformational leaders pursue and create the opportunities needed towards achieving the
outcomes necessary to ensure patients are turned every two hours without exception. Conger
(1999), supports this supposition by suggesting that transformational leaders inspire their
employees to commit to the organizational strategies whereby enhancing employee performance
while at the same time increasing efficiencies which ultimately leads to significant cost
reductions.
l. How will you assess or measure whether your improvement project worked? How/will
informatics technology be used?
The risks of obtaining pressure ulcers will be determined by assessing the patients body
temperature, observing devises in contact with the patients skin, friction points, pressure points,
shear areas, patient nutrition, identification of patients mobility, and the potential inability to
communicate pain. Assessing areas of redness or non-blanch able conditions early as a
preventative measure can become an important measure as well. Documenting these findings
electronically will help with the evaluation of data to gain an understanding of outcomes through
the use of informatics.
Using the Norton Pressure Ulcer Scale as a measurement tool for scoring the risks of
obtaining pressure ulcers would provide more accurate data to enter into the system (Voz, A.,
Williams, C., & Wilson, M., 2011). With the informatics tools, the collected data can be used to

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measure trends or patterns showing effectiveness or weaknesses in the process. Once the new
turn team process is implemented, a continued evaluation of the process will be needed to
maintain continuous improvement. The Plan-Do-Study-Act (PDSA) cycle is used to test,
observe the results, and act on what was learned (Deming, 2015). Using the PDSA cycle will
continuously monitor effectiveness of the new turn team process.
J. Predict what you think will happen as a result of your improvement project.
Being an outsider to the organization, It is important to prepare for a lot of resistance to
change. There are many demands placed on the staff daily, and adding additional procedures to
their already demanding schedules will not go over well. Having enough data to justify the need
for change will contribute to receiving buy-in from a majority of the stakeholders. At first I
believe members will see the importance for implementing turn teams. Through utilizing this
process regularly after the first month, there will be a dramatic decrease in hospital obtained
Stage I and Stage II pressure ulcers. Using a unit size of fifteen to twenty beds, the unit would
have an average of eighteen patients to tend to. Based off the Still, M. (2013) about half of the
study group patients were treated as a preventative measures. The study showed the turn team
effectiveness to almost eliminate Stage I and Stage II pressure ulcers. In a unit of eighteen
people, this would prove to prevent approximately four to five patients a month from obtaining
pressure ulcers requiring extended hospital stays. This could result in a 30% reduction in
extended patient stays potentially saving the hospital up to $70,000 - $100,000 per patient.
These expenses are no longer reimbursed to hospitals as they are preventable with proper care
(Voz, Williams, and Wilson, 2011). This small unit alone has a potential of saving $280,000 to
$500,000 monthly.

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Using Lewins Change Theory will provide the direction and the needed communication
aspects for expressing and subsequently validating the need for change. To ensure this change
process achieves a successful implementation, it is important for stakeholders to see and buy-in
to the vision to successfully achieve the targeted quality improvement outcomes in a timely
fashion. Without the necessary buy-in from management and key personnel, this will be a
difficult project to implement successfully.
K. Create goals, objectives, and timelines for the project: See Appendix B

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References
American Nurses Association. (2009). Nursing: Scope and Standards for nurse administrators.
Washington, D.C.: American Nurses Association.
Batcheller, J. (2012), Learning How to Dance: Courageous followership a CNO Case Study.
Nurse Leader, 22-24. Doi:10.1016/j.mnl/2011.12.006
Carper, B. A. (1978). Fundamental patterns of knowing in nursing. ANS Advances in Nursing
Science, 1(1), 13-23. Retrieved from: http://ferris.libguides.com
Change. (2005). In Encyclopedia of Evalustion. Retrieved from Credo Database.
Clancy, T. R., Effken, J. A., & Pesut, D. (2008). Applications of complex systems theory in
education, research, and practice. Nursing Outlook, 56(5), 248-256.
Conger, J. A. (1999). Charismatic and transformational leadership in organizations: An insiders
perspective on these developing streams of research. Leadership Quarterly, 10(2), 145
179.
Deming, E. (2015). The Plan Do Study Act (PDSA) Cycle. The W. Edwards Deming Institute.
Retrieved from https://www.deming.org/theman/theories/pdsacycle
Doody O. & Doody, C. (2012). Transformational leadership in nursing practice. British Journal
of Nursing 21 (20), 1212-1218.
Graban, M. (2012). Lean hospitals: Improving quality, patient safety and employee satisfaction
(2nd ed.). Boca Raton, FL: CRC Press.
Hagisawa, S., & Ferguson-Pell, M. (2008). Evidence supporting the use of two-hourly turning
for pressure ulcer prevention. Journal of Tissue Viability, 17(3), 76-81. doi:
10.1016/j.jtv.2007.10.001
Hill, M. H. (2002). Transformational leadership in nursing education. Nurse Educator, 27(4),
162-164.

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Hobbs, B. (2004). Reducing the incidence of pressure ulcers: implementation of a turn-team

nursing program. Journal of Gerontological Nursing, 30(11), 46-51.
Lewin, K. (2011). Change Theory: Nursing Theories, a companion to nursing theories and
models. Retrieved from: http://currentnursing.com/nursing_theory/change_theory.html
Kotter, J. (1996). The 8-Step Process for Leading Change. Kotter International. Retrieved from
http://www.kotterinternational.com/the-8-step-process-for-leading-change/
Marshall, E. (2011). Transformational leadership in nursing: From expert clinician to influential
leader. (1st ed.). New York: Springer Publishing Company, LLC
McHaney, D. (2013). Information Management and Technology. Management and Leadership
for Nurse Administrators, 6th Edition. Jones & Bartlett Learning. Retrieved from
http://www.jblearning.com/samples/0763757144/57144_ch13_428_452.pdf
Sherwood, G., & Barnsteiner, J. (2012). Quality and safety in nursing: A competency approach
to improving outcomes. Hoboken, NJ: John Wiley & Sons.
Sill, M. D., Cross, L. C., Dunlap M., Rencher, R., Larkins, E. R., Carpenter, D. L.,
Coopersmith, C. M. (2013). The Turn Team: A Novel Strategy for Reducing Pressure
Ulcers in the Surgical Intensive Care Unit. The American College of Surgeons. 373-379.
Selanders L. C. (1998). The Power of Environmental Adaption: Florence Nightingales Original
Theory for Nursing Practice. Journal of Holistic Nursing 16(2) 247-263. doi:
10.1177/089801019801600213
Sullivan N, & Schoelles KM. (2013). Preventing In-Facility Pressure Ulcers as a Patient Safety
Strategy: A Systematic Review. Ann Intern Med. 2013; 158:410-416.

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Voz, A., Williams, C., & Wilson, M. (2011). Who Is Turning the Patients? A Survey Study.
Wound Care. J Wound Ostomy Continence Nurs. 38(4), 413-418.
University of Texas Science Center at Houston School of Nursing. Turn study overview
Retrieved from: https://nursing.uth.edu/coa/turn_overview.htm

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Appendix A
Student-Preceptor Agreement
The overall objective of this experience is to provide an on-site setting in which a student, with
the preceptor (professional employee of a health care agency), will complete a quality
improvement project. An updated signed agreement will replace this one.
Agency name: Detroit Medical Center (DMC) Detroit Receiving Hospital (DRH)
Student name: Melissa Diebel
Student Telephone #: (248) 622-9336
Preceptor Name: Toni Grant, DNP, RN, ACNS-BC, ACNP-BC
Preceptors Title: Corporate Director Practice Environment
Preceptor Telephone # (313) 966-0483
Preceptors Email tdgrant@dmc.org
The following goal(s), objectives, and activities will be completed by the student during this
project/practicum.
Goals:
To create a budget neutral process for turning patients while establishing a culture of safety.
Objectives:
To establish a culture of safety to reduce the risks of patients obtaining pressure ulcers.
Activities:
Activities will include observation, conducting the RCA. Performing a time study and work load
assessment to formulate the current state of the organizational culture as the foundation to
produce a GAP analysis. Finally developing the plan utilizing Lewins change theory, for a
neutral process and implementation. Understanding where the group is now on assessment
accuracy, and how their time is utilized based on workload, will provide the starting point to
determine how to fit in a turn team process to obtain the goals for this project. Implementing the
process will consist of utilizing Lewins change theory based on the timeline for the project.
SIGNATURE SIGNIFYING AGREEMENT TO THE TERMS OF THIS PRECEPTOR
AGREEMENT:
Student:
_____________________________________ Date: May ,2015
Preceptor(s) ______________________________________ Date: May
______________________________________

,2015

_Date:__________

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Student-Agency Agreement
Agency Name: Detroit Medical Center (DMC)
Student name: Melissa Diebel
Student Telephone #: (248) 622-9336
Agency representative: Toni Grant, DNP, RN, ACNS-BC, ACNP-BC
Agency representative Title: Corporate Director Practice Environment
Agency representative Telephone #: (313) 966-0483 Email: tdgrant@dmc.org
SIGNATURE SIGNIFYING AGREEMENT TO THE TERMS OF THIS AGREEMENT:
Student _________________________________________

Date: May

, 2015

Agency Representative _____________________________

Date: May

, 2015

Diebel,M.TurnTeams.PlanA-Draft2

Appendix B
QUALITY IMPROVEMENT PROJECT PROPOSAL PLANNING GUIDE
Title of Quality Improvement Project: Turn Teams

Goals with QSEN/ANA Support

Sub-Objectives to meet Goal

Activities to meet Each Sub-objective Timeline for each

Goal 1: State Goal

1.1 Gather data

1.1 Understand the extent of turn

1.1 Week 1 5-24-15
teams, learn the workload and
Week 2 5-31-15
schedules the staff, and document how
pressure ulcer prevention is evaluated,
gather data on patients with hospital
obtained pressure ulcers, identify the
severity of current pressure ulcers,
obtain percentage of patients who
required extended hospital stays
beginning with January 2015, and costs
associated with treating pressure ulcers.

Write a process for implementing turn

teams to prevent hospital obtained
pressure ulcers.

Meets QSEN Competency(ies)/KSA(s):

Informatics - (Knowledge)

1.2 Establish a sense of urgency

Quality improvement - (Knowledge)

1.2 Communicate findings to

stakeholders defining the issue, safety
concerns, and costs associated with
them.

1.2 Week 3 6-7-15

Teamwork & Collaboration - (Skills)

Meets ANA Scope & Standards for

specialty role:

1.3 Create a guiding coalition

20

1.3 Establishing a team with credibility

and leadership skills who will support
the need for change and assist in
developing and driving the change.

1.3 Week 4 6-14-15

Diebel,M.TurnTeams.PlanA-Draft2
Standard 1. Assessment
Standard 11. Communicate
Standard 13. Collaboration
Standard 14. Professional Practice
Evaluation
Standard 15. Resource Utilization

1.4 Develop a shared change

vision and provide a picture of
the shared vision in a simple
way and collectively develop a
plan.

1.4 Perform a Root Cause Analysis

(RCA) with the team to show current
status and intended goal to achieve.
Collectively work towards how to fill
the gap towards the goal.

1.5 Communicate vision for

buy-in and

1.5 Finalize pulling together the team

who will be working together on the
intended change to add the turn team
process. Collaborate on the new
quality improvement plan to finalize
details before implementation.

2.1 Empower action.

Goal 2: State Goal

2.2 Generate visible short-term

wins

Implement the process of adding turn

teams.
Meets QSEN Competency(ies)/KSA(s):
Patient Centered Care (Ability)
Teamwork & Collaboration (Skills)
Meets ANA Scope & Standards for
specialty role:

2.3 Dont let up avoid

declaring victory to soon

21

1.4 Week 5 6-21-15

1.5 Week 6 6-28-15

2.1 Implement the plan, allowing team

members to make decisions and
contribute to developing the new
process around patient centered care

2.1 Week 7 7-5-15

2.2 Review the need with leadership to

develop a reward system for
recognizing small wins during the
implementation process. Identify if
employees have been publically
recognize for their accomplishments.

2.2 Week 8 7-12-15

2.3 Continue to emphasize the

importance of continuous improvement
with the new process.

2.3 Week 9 7-19-15

Diebel,M.TurnTeams.PlanA-Draft2
Standard 4. Planning

2.4 Safety buffer in schedule

2.4 Scheduling a safety buffer for

unexpected implementation delays, or
more time to monitor the effectiveness
of the new process.

2.4Week 10 7-26-15

2.5 Anchor the change in this

culture

2.5 Continue to monitor and measure

effectiveness of the process utilizing
the Plan Do Study Act (PDSA) method
to anchor this process as the new norm
(Deming 2015).

2.5 Week 11 8-7-15

Standard 5. Implementation
Standard 6. Evaluation
Standard 10. Quality of Practice
Standard 12. Leadership

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Diebel,M.TurnTeams.PlanA-Draft2

Appendix C

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Diebel,M.TurnTeams.PlanA-Draft2

24