Archive August 2017 XVIII, No. 8

8 Ways to Prevent Pressure Ulcers

How to maintain the integrity of each patient's skin.

Diane Kimsey, MSN, MHA, RN, CNOR, CLO

pre-op nurses POSITIONAL PLAY Making sure pre-op nurses know the pressure points associated with a patient's anticipated surgical position can help to prevent pressure ulcers.

I've spent more than 40 years working in health care, and preventing pressure ulcers in the OR has become a priority only recently. We used to think the patient wasn't in the OR long enough to acquire a pressure injury, but these days we're much more aware of how quickly and easily a patient's skin can become compromised — and how costly and potentially dangerous it can be when it does. (see "The Heavy Burden of Pressure Ulcers" on page 59).

Having patients leave your facility with their skin intact requires a multi-pronged approach. Beginning in July 2015, our medical center implemented a bundle of initiatives to prevent pressure ulcers for patients throughout their length of stay, whether they're in ambulatory surgery or one of our critical care or interventional units. These initiatives included:

1. Staff education and communication. Prevention begins with knowing the risk factors and how to effectively manage them. Who's most at risk? Broadly speaking, any patient in a procedure lasting 3 hours or more should be considered high risk, as should anyone with a score of 16 or below on the Braden Scale for Predicting Pressure Sore Risk ( and a body mass index of 19 and below or 35 and above.

Resources and toolkits from the Association of periOperative Registered Nurses and the Agency for Healthcare Research and Quality can help you teach pre-op and post-op nurses the ins and outs of prevention and treatment, including how to identify the telltale signs of a pressure injury and how to stage an injury accurately. These tools can also provide guidance on which parts of the body will be vulnerable to pressure injuries based on the patient's anticipated surgical position. After all, if you don't take the time to educate the staff about surgical positions, how will they know how the pressure points differ between, say, lithotomy position and prone position?

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