Perioperative pressure ulcer prevention: Communication between the perioperative environments is one key to success

As a hospital, we continue to look for areas to improve our practice and address nursing sensitive quality indicators. Hospital acquired pressure ulcers (HAPUs) continue to pose a challenge. A drill down looking at areas of the hospital that may be contributing to the overall HAPU rate was undertaken by our Quality Council. The data suggested the perioperative department might be contributing to our HAPU rate. On our initial drill down, the data suggested a significant number of patients who developed a HAPU had a surgical procedure within 5 days of developing the pressure ulcer.

The purpose of this practice innovation was to increase the perioperative staff’s awareness regarding how pressure ulcers develop in the perioperative environment and to facilitate assessment, documentation, communication, and implementation of nursing interventions to prevent hospital acquired pressure ulcers in the perioperative environment.

The objectives were: 1) Develop a Perioperative Pressure Ulcer Prevention Team; 2) Educate the perioperative staff regarding the pathophysiology of pressure ulcers and their role in preventing hospital acquired pressure ulcers; 3) Develop a tool to facilitate communication and hand off of interventions between the three-perioperative environments. The tool is part of the medical record and provides information to the health care team on the length of the procedure, the position of the patient and the perioperative nursing interventions. Some of the nursing interventions include a pre-op Braden scale score, absorbent pad under the patient, pressure redistribution devices, patient repositioning pre and post procedure.

The outcomes of these interventions have shown an increased compliance of the perioperative staff to actively prevent pressure ulcers and willingness to use the PPUP Tool to communicate between perioperative departments. After implementing the education and the PPUP Tool, we noted a 38% reduction in patients who had a surgical procedure within 5 days to developing a HAPU.