A Study Aimed at Improving Assessment and Documentation of Skin Inspection and Pressure Ulcer Risk in Spinal Surgery Patients during the Perioperative Period

Background:  Distinguishing between pre-existing skin lesions and hospital acquired pressure ulcers (HAPUs) in surgical patients is important.  Lack of inspection and documentation of patient’s skin status pre-operatively with incomplete hand-off regarding skin status and pressure ulcer risk among perioperative nurses was identified as a problem at our community hospital.

Purpose:  To improve consistency and accuracy of skin and pressure ulcer risk assessment and documentation by perioperative nurses.

Method: A one group pre- and posttest quasi-experimental design was used.  A three month retrospective review of electronic medical records (EMR) to audit documentation of pre-existing skin lesions and Braden pressure ulcer risk assessment scores and for documentation of HAPUs at 24 and 48 hours postoperatively for spinal surgery patients was completed.  A one month education/coaching program for perioperative nurses was the study intervention.  Post intervention, a six week audit of perioperative through 48 hours postoperative skin assessments and Braden scores via EMR was completed.

Results:  Analysis showed an increase in skin assessment documentation in the preoperative area from 68 to 100% and Braden score documentation from 4.1 to 96%.  Hand-off of skin assessment preoperative to operative staff increased from 4.1 to 83.3%; OR to PACU staff from 50 to 75% and PACU to floor staff from 4.1 to 56.2%.  Documentation of skin assessment changes in PACU, including resolution of erythema over bony prominences – which had never been noted prior to intervention—was documented.

Conclusion:  Education to demonstrate value of skin assessment and documentation is an effective strategy in perioperative pressure ulcer prevention.