Exploring Skin Care Strategies During the Perioperative Process

Background: Increased incidence of sacral breakdown noted in the total knee arthroscopy population.  A multidisciplinary team convened. Topics identified for exploration included surgical positioning, friction and shear, linen usage, and immobility.  Increased communication between Perioperative staff, inpatient nurses, and management to review and identify resources. Multiple ports of entry into the hospital required collaborative approach to care.

Purpose:  Identify risk factors for skin breakdown in the surgical population. Develop a standardized skin assessment and documentation process for all hospital patients. Educate all staff on the importance of incorporating skin assessment in handoff communication.

Method: Retrospective review of charts to identify patient commonalities. Consult with national experts and review of the literature. Site visit to outside hospital Spinal Cord Injury Unit as exemplar of best practice. Identification of specific products to prevent and treat pressure ulcers. Collaborate with nursing colleagues at all points of entry to incorporate full skin assessment as part or nursing admission assessment.

Findings/Outcomes:  Educational program presented to pre-operative test center staff and Nursing Grand Rounds identifying the need for a full skin assessment upon admission. Implemented a communication process among perioperative care providers. Tools were changed to improve documentation. Documentation of the Braden Scale by pre-admit test center, perioperative, and inpatient nursing staff. Increased interdisciplinary awareness of resources to manage patients with skin integrity issues. Skin care template kept in bedside books.

Conclusions/Implications:  Validated the need for increased awareness, education, and changes in nursing practice to ensure optimal skin care for all patients.

Future Directions: Periopertive nursing education, annual skin integrity competency, unit based skin assessment tool box, Perioperative risk factor chart, preventative skin care algorithm, and skin integrity reconciliation at discharge.