Intervention to Avoid Branding to the Occiput

Purpose

The purpose of this project is to decrease occipital Hospital-acquired pressure ulcers (HAPU) rates in supine cardiothoracic surgical cases greater than 4 hours by using a fluidized positioning device (FPD).

Objective/Relevance/Significance

HAPU are a patient safety issue.¹ In the US, national estimates of the incidence of HAPU in surgical patients is reported as high as 66%.²   Supine cardiothoracic surgical cases in a mid-west tertiary academic medical center main OR account for approximately 400 cases per year and last year there were 15 reported injuries.  Injuries initially ranged from blanchable erythema to deep tissue injury.  More importantly, all of these progressed to full thickness injuries, meaning permanent hair loss and disfigurement for these patients.

Strategy and Implementation

There is a lack of evidence-based practices available to prevent HAPU in OR patients so an interdisciplinary OR HAPU prevention workgroup was formed. Recommendations and funding were made for the following interventions to prevent OR related injuries:

1. Utilizing a FDP for all supine cardiothoracic surgical cases scheduled for 4 hours or greater.^3-5
2. Standardized educational content required for all OR staff involved in implementing prevention interventions for patients. 
3. Consultation of the Wound/Ostomy service for all skin injuries.

Evaluation

Plan is to continue to monitor for the reduction of HAPU in the supine cardiothoracic cases at UIHC.  Data will be obtained via chart abstraction, incident reports of HAPU and Wound/Ostomy consultation review.