Preventing Pressure Ulcers in the Prone Perioperative Patient
Candi Haggard, RN CWOCN, Joselito Tiamson, BSN RN, Letha Mathews, M.D. of Anesthesiology, James Blair, D.O.
The purpose of this quality improvement project is to reduce the incidence of developing pressure ulcers during neurosurgery
The risk of developing a pressure ulcer during neurosurgery is substantial. There were 11 wound consults for chin breakdown after neurosurgery during the three months before this project was initiated. Length of surgery, prolonged prone position, and drooling during surgery put neurosurgical patients at increased risk. The most common site for pressure ulcers to develop was the chin. The development of pressure ulcers was causing increased costs and often times increased LOS. A practice change was needed to prevent these pressure ulcers from developing.
As part of this project, multiple prevention interventions were trialed. All failed to change outcomes. The use of a five-layer soft silicone foam bordered dressing was trialed for 1 month on patients undergoing neurosurgery planned for four hours or greater. The foam dressing was applied to the chin prior to surgery. Data were collected on gender, age, procedure, time spent in the prone position and the incidence of breakdown on Post-op Day 1.
Data were collected on 28 patients during the one month trial. The average time spent in the prone position was 5.5 hours. No incidence of skin breakdown was noted on Post-op Day1. However, some of the patients developed breakdown on other anterior pressure points that did not have the foam dressing applied.
Application of a five- layer soft silicone foam bordered dressing did prove effective in preventing pressure ulcers on the chin area. Continued application to the chin area as well as other anterior pressure points will be necessary to prevent development of pressure ulcers in prolonged neurosurgery patients.