Peri-operative Pressure Ulcer Prevention Initiative

PURPOSE: Development of operating room (OR) related pressure injuries and inconsistencies in care were identified by OR RN staff as a quality of care issue. A group of peri-operative nurses and the WOC nursing team of a large level 1 trauma center in the North East convened to evaluate this.

The purpose of the initiative was to:

1. Implement standard nursing assessment & care throughout the peri-operative areas to prevent facility acquired pressure injuries.
2. Utilize an interdisciplinary hand-off tool to communicate pertinent data regarding the patient’s course in the peri-operative areas.

METHODS:

Literature review was undertaken. Current practice and best practices were identified.  A standardized practice for pressure ulcer prevention in the peri-operative areas was developed and implemented. Education was done in April 2017 & the change was implemented in May 2017.

 

Upon admission to perioperative area, patient skin assessed and screened patients who are at risk for skin breakdown based on:

• Surgery anticipated lasting 3 hours or greater
• BMI <19 or >40
• Previous or current pressure injuries
• Age 70 or greater
• Bedbound, chair bound or decreased sensation

If patient met criteria, preventive foam dressing was placed. As a patient progressed through perioperative course, screening was performed, skin assessed, unit specific preventive measures placed, and formal handoff tool utilized to enhance communication.

RESULTS: In the first four months of 2017 prior to implementation, there were 9 documented OR related pressure ulcers. In the four months after implementation, 2 were identified. Data will be collected and evaluated quarterly in the future.

CONCLUSIONS: Collaborative interdisciplinary initiative between peri-operative areas resulted in evidence based practice change to improve patient care, communication and outcomes.