Perioperative Pressure Ulcer Reduction Strategies

Many acute care facilities across the United States have implemented pressure ulcer reduction strategies. These strategies aim to reduce the risk of harm to patients while in the medical/surgical, intensive care, and telemetry environments. A patient in the acute care setting is at risk from other components of inpatient care, most notably the operating room (OR). Pressure ulcer formation related to positioning while in the OR may lead to increased hospital length of stay, increasing costs between $14,000 and $40,000 per patient ³.  Patients in the OR for longer than three hours are at an increased risk for pressure ulcer development ³.  An interdisciplinary team consisting of anesthesiologists, certified registered nurse anesthetists, operating room nurses, post-anesthesia care nurses, medical surgical nurses, and the CWOCN set about to develop a guideline to protect patients undergoing spinal surgery at a 226 bed suburban Philadelphia hospital facility performing approximately 500 such procedures yearly.  This team completed a needs assessment, revealing that education, and positioning tools to decrease friction and shear forces when proning patients were needed. Educational sessions were done with the anesthesia department, resulting in an agreement to reposition the head every 15 minutes during the procedure. The use a skin protectant prior to securing the endotracheal tube for the procedure was also employed. Extrapolating from studies done in critical care which have shown silicone foam dressings to be an effective tool in prevention of pressure ulcer development, these same dressings were applied to the chin, forehead, and pressure points on the trunk prior to proning the patient. Lastly, gel cushions were purchased for the surgical frames used in these procedures. The interdisciplinary team monitors the use and implementation of the guideline. These initiatives successfully reduced pressure ulcer development in this vulnerable patient population to zero in the last 9 months.