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Archive January 2016 XVII, No. 1

Reduce the Risk of Pressure Ulcers

Skin injuries can occur without preventative measures in place.

Joyce Black

Joyce Black, PhD, RN, CWCN, FAAN


Pressure injury clock PADDED LAYERS The pressure injury clock
starts ticking as soon as anesthesia kicks in.

Pressure ulcers that manifest during post-op hospitalization or after same-day discharge could have started in the OR. In years past, the OR staff might say the patient wasn't in the OR long enough for an injury to occur. Or they'd deny it happened during surgery, because a skin examination at the end of the case didn't reveal any suspicious-looking red spots. But today, wound nurses who see skin injuries and take the issue back to the OR are increasingly met with caregivers who are receptive to processing and addressing the information.

Yes, the risk of pressure ulcers developing increases the longer anesthetized patients with unprotected soft tissue remain on the OR table. And it typically takes 48 hours for the ulcer to show at the skin's surface, so it's often difficult to link it to what occurred in the OR. A combination of forensics and an understanding of how deep tissue injuries develop have led caregivers to take another look at the factors during surgery that can cause pressure ulcers and have increased awareness that injuries might not be apparent in the typical locations. For example, patients who are in the supine position during surgery can develop pressure ulcers on the buttocks, not necessarily on the sacrum or coccyx, as is often assumed.

Outpatient procedures are shorter in duration and generally performed on healthier patients who are ambulatory soon after surgery, so pressure injuries are less likely. However, the risk still exists, because an increasing number of lengthy, complex procedures are being performed on acute patients in the same-day setting. Although the likelihood of pressure ulcers occurring during outpatient procedures might be lower than during inpatient procedures, the risk of being slapped with a medical malpractice lawsuit might be higher when injuries occur in ambulatory facilities, where patients often have less tolerance for error when undergoing elective surgeries. It's good risk management practice to document the precautions you have in place.

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