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Archive February 2021 XXII, No. 2

Rethinking Pressure Injury Prevention

A surprising skin injury led to the launch of a hospital's effective risk-reduction program.

Daniel Cook

Daniel Cook, Editor-in-Chief


Diane Kimsey
SKIN IN THE GAME Safe patient positioning demands staff buy-in and excellent communication among all members of the patient care team.

The two-inch red circle on the patient's sacrum was unmistakable. A PACU nurse noticed the deep tissue injury during a post-op assessment and called over to pre-op to see if one of her colleagues had documented the patient's skin condition before surgery. No one had. The 51-year-old male patient with a BMI of 44 had undergone a left distal open reduction and internal fixation, an outpatient procedure that typically takes 90 minutes to complete, but this case had unexpectedly lasted more than three hours. All told, including time spent in pre-op, the patient was supine on a stretcher for five hours.

"We didn't have a pressure injury prevention program in place at our on-campus surgery center, so a pre-op baseline skin assessment wasn't done," says Diane Kimsey, MSN, MHA, RN, CNOR, CMLSO, WTA, perioperative educator at Einstein Medical Center Montgomery in East Norriton, Pa. "At the time, we weren't sure if the patient presented with the injury or had acquired it during surgery."

Many surgical nurses float between Einstein's inpatient ORs and its ASC, so they're familiar with the comprehensive pressure injury prevention program in place at the main hospital. "We had to determine what protocols could provide the same level of protection for patients in the ambulatory setting," says Ms. Kimsey.

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