Pressure Ulcer Assessment and Management in the PACU

Background: As of October 2008, CMS has cut reimbursements for hospital acquired pressure ulcers.  Since the PACU is a transient unit, the staff do not consider skin assessment as a major concern.  Because majority of patients having surgeries come in on the day of their procedures, their risk for developing skin issues has not been assessed.   Current trends, such as bed shortage in the hospital, increasing numbers of obese and diabetic patients, complex surgery and anesthesia procedures, has multiplied the risk factors for patients to develop pressure ulcers.  Since the PACU is entry port for most elective surgeries, it is essential for staff to be aware of the problems associated with pressure ulcers.

Objectives: Identify risk for pressure ulcers on patients with elective surgery

                       Implement risk and skin assessment scale

                 Implement pressure ulcer management protocol

Implementation: A survey and chart audit was done to determine the current practice in the unit.  A powerpoint presentation was held, discussing the importance of identifying risk factors, applying the Braden Scale, providing interventions and changing documentation process.  Follow up survey was made to measure improvement.

Statement of Successful Practice:  Interventions for prevention of pressure ulcers are not initiated in the PACU.  High risk patients are being identified and appropriate care is being provided. PACU transfer of care report includes risk assessment scale and skin status.  This gives floor/icu nurses ample time to acquire necessary supplies and equipment prior to their patients admission.

Positive Outcomes:  Being able to apply the Braden Scale in the PACU made it easier to determine preventative measures for the skin condition.

Implications for Practice:  Pressure ulcer management should start in the PeriAnesthesia setting for all patients having elective procedures