Perioperative Skin Assessment Tool

Abstract

Perioperative Assessment tool-

The perioperative team at Norwalk Hospital expressed a wish to be proactive in preventing the occurrence of pressure ulcers in the operative patient census . The team consisted of the hospital wound care nurse, the OR and PACU managers and the OR  Director and educator.  The initial goals were to obtain an accurate pre-op skin and wound assessment, document those patients at increased risk for breakdown and provide consistant assessment and documentation during the entire perioperative period.

A team was selected to explore the existing information on operating room acquired pressure ulcers. We were able to obtain an pre-existing OR assessment tool and elected to build an expanded perioperative form to include pre-op assessment in the holding area, intraop assessment to be assessed in the operating room and a post-op assessment to be performed in the PACU. The form needed to be one sheet of paper , easy to use, with a checkbox system of documentation to encourage acceptance of a new assessment tool.

We met weekly to define our goals, review current research and develop the assessment tool. As we continued to refine the tool many questions arose which needed to be addressed before we could finalize the tool and begin the initial pilot study. Some of the issues were:

·        How to insure skin /wound assessment competency with the OR staff who previously were not required to perform Braden Scale assessments

·         Would there be exceptions to which patients required assessment? Trauma patients? Emergencies from the GI lab who may be presenting as very hemodynamically unstable? Pediatric patients ?

·        Definitions of hemodynamically unstable .One short drop in BP, a sustained hypotensive event, were pressors needed?

·        Who would perform the Braden Score assessment ?

·        Education for the perioperative team to accurately assess the Braden score