It's No Skin Off My Back: Preventing Peri-operative Related Skin Injury in the Pediatric Patient

The issue of hospital acquired skin injury, including pressure ulcers, has been addressed in the acute care population at many pediatric institutions. Through pressure ulcer prevention programs, development of skin champion teams, and the use of preventative products, patient outcomes have improved. Point-prevalence studies and incidence monitoring are used to trend these outcomes and help target interventions in the inpatient setting to continually decrease hospital acquired skin injury. Despite all of these improvements in care, the specific needs of the pediatric perioperative population have not been fully addressed. These patients are considered at highest risk for skin injury due to general anesthesia, length of procedure, procedure-specific positioning, and use of various medical devices. The process for skin assessment, determining skin injury risk, and the selection, application and documentation of interventions was not consistent across the peri-operative continuum at our institution. A Peri-operative Skin Work Group was created to address these deficits in practice and institute a culture change in the peri-operative units. After achieving consensus on patient skin assessment requirements, our work included an ongoing review of peri-operative-related skin injury cases, a thorough review of the literature, revision of peri-operative nursing standards, development of patient and family education materials, scripts for use in working with the adolescent population, the addition of dressing products and surface options in the OR and PACU, guidelines for hand-off communication, and an interactive on-line learning module. This presentation outlines our step-by-step approach for implementing skin injury prevention practices through all phases of peri-operative care for the pediatric patient.