To the Editor:

It is a pleasure reading the article by Voz and colleagues,1 "Who Is Turning the Patients?" It is very educational and relevant to the issues faced by WOC nurses in any healthcare setting. I am currently working in a 350 bed acute facility and being the only WOC nurse in the building I certainly have challenges in attaining our goal of "0 hospital-acquired pressure ulcers."

It is a common knowledge that prevention is the key to avoid the occurrence of pressure ulcers. Prompt and accurate identification of at-risk patients is the first in line in defense allowing timely initiation of skin risk interventions.2 The significance of using a risk assessment tool is an essential component to the clinical practice to identify patients at risk.3 Despite the availability of more patient-specific information, it is the responsibility of the staff to implement the appropriate measures to prevent the development of hospital-acquired pressure ulcers.4

Turning and repositioning every 2 hours is in every wound care prevention protocol, but how diligently implemented is the challenge. I believe that the statistics shown in this article are close to, if not similar to, the findings of other hospitals. My wound care team has been struggling to find ways to improve the compliance of turning. Currently we are in the process of implementing the following clinical practice guidelines:

* Turning log posted in the patient's room. The nurse or the technician has to sign the log every 2 hours when the patient is turned. The side to which the patient is turned is specified.

* Organizing a turning champion in every unit who will lead during "Turning Timeout."

* List of high-risk patients (Braden score of below 18) provided during shift-to-shift reporting.

* Empowering of nursing assistants to be actively involved in skin care programs. Urgent reporting of high-risk patients to nurses is encouraged.

These guidelines are effective in our current setting; however, what works in one setting does not necessarily work in another. Hopefully these guidelines will generate more ideas to improve pressure ulcer prevention, early detection, and management in other facilities.

Skin integrity is identified as one of the core measures of nursing care quality and is associated with economic burden and costs containment. Guidelines of prevention and early detection are essential to avoid hospital-acquired pressure ulcers. I believe that to be able to effectively implement guidelines to nursing practice, a full support from nursing administration is critical. Skin care is not only within the domain of the Wound Care Team and nursing service. To be able to achieve the goal of 0 hospital-acquired pressure ulcers, it involves a sincere commitment from the top-, middle-, and lower-level of leadership to support wound care programs.

I look forward to reading more articles on this topic.

Veronie Berioso, RN, BSN, CWCN

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