Archive November 2014 XV, No. 11

How We Beat Pressure Ulcers

The 7 things we did to lower our skin injury rate.

Melanie Pipping, BGS, RN, CNIII


positioning a patient POSITION PROPERLY Positioning a patient is one of the biggest ways to help your facility fight pressure ulcers.

If your patients are developing pressure ulcers after surgery, read on for several strategies sure to cut your skin injury rate. A few years ago, when my hospital noticed an unacceptably high number of our patients were developing skin injuries 72 or so hours after surgery, we formed a Perioperative Services Skin Wellness Committee, which I chaired. Based on our experience, here are 7 things you can do to prevent pressure ulcers.

1 Check under the mattress
One of the most impactful changes was updating our OR mattresses. We were using 2-inch foam mattresses with hard plastic covers. To combat the hardness of the mattress, we used gel overlays. To fight the cool temperature of the gel overlays, we placed water-circulating warming blankets underneath them. It was a self-defeating system.

We had a few 3-inch thick, high-quality memory foam mattresses in some of our ORs, but we were sandwiching those between warming blankets and gel overlays. The thin mattresses, gel overlays, and heat and moisture from the blankets created the perfect environment for pressure ulcers and wounds. We educated staff on best practices for using the high-quality memory foam mattresses, with only a single sheet cover instead of the warming blanket and gel overlays, and transitioned all of the ORs to the high-quality memory foam mattresses. We selected the 3-inch versions because we do a number of bariatric procedures, and patients with larger BMIs could bottom out on 2-inch thick mattresses.

2 Rethink your method of patient warming
There was another part of the OR table that we had to correct — our "old-school" water-circulating warming blankets. There were 2 big problems with the thin, blue, plastic warming blankets. First, they were placed underneath the gel overlays, which were often smaller than the blanket in some areas, occasionally causing burns if a patient's skin got in contact with the blanket. Second, the blankets were plastic and circulated warm water. By using them, we were trapping heat and moisture underneath patients, contributing to pressure ulcers.

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