Archive June 2014 XV, No. 6

Protect Patients From Pressure Injuries

4 questions to improve surgical patients' skin care outcomes.

Megan Dooman, RN, BSN, CNOR


obese patients RISK GROUP For obese patients, as with the elderly and those with circulation-related co-morbidities, special attention must be paid to padding and support during positioning.

The risk of pressure injuries is often overlooked, especially in outpatient surgery, where patients ambulate so soon after their procedures. But even temporary surgical positioning and immobilization can lead to perioperative skin breakdown, nerve injury, or musculoskeletal or vascular damage. As the skin care champion for my hospital's ORs, I routinely meet with other nurses and managers to identify quality improvement opportunities and reduce our hospital-acquired pressure ulcer rates. To ensure the best outcomes for your patients, and to banish this "never event" from your ORs, ask yourself these 4 questions about pressure injury prevention.

1. Are your patients at risk?
Would you know it if your surgical patients commonly faced the risk of pressure injuries at your facility? It might be advisable to examine the steps of your perioperative process in an effort to adopt best practices and improve patient outcomes.

For a project we eventually developed into a poster presentation at an AORN conference, we consulted with outside skin care experts, including clinical educators and product representatives, and conducted a search of the medical literature. We gathered and reviewed evidence, including appraisals of perioperative standards and recommended practices, to which we could compare our process and from which we could implement changes.

2. How are you reducing the pressure?
One of the most significant findings of our review was that a lot of our OR tables were topped with older mattresses. There were several types, but most of them were made from conventional sponge foam, which led us to ask: What is the best surface for patients to be on throughout surgery? We sometimes see trauma cases in which patients are on their backs for 8 or 10 or 12 hours of surgery, and there's no doubt that pressure plays a role there.

Materials technology has come a long way since those OR mattresses were installed. According to clinical research, viscoelastic "memory" foam, gel-filled cushioning options and products that couple the two offer highly effective pressure redistribution and patient support, which can prevent the restriction of blood flow, insults to peripheral nerves, and their attendant complications.

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