Abstract: Preventing Pressure Injuries in the Prone Perioperative Patient (50th Annual Conference)

Candi Haggard, CWOCN, Wound Ostomy, Vanderbilt University Medical Center, Nashville, TN, Susan Hodgin, MSN, RN, CNOR, CSSM, Perioperative Services, Vanderbilt University Medical Center, Nashville, TN, Buffy Lupear, DNP, CRNA, APRN, Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, Sheena Weaver, MD, Anesthesiology and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN and Letha Mathews, MD, Neuroanesthesia, Vanderbilt University Medical Center, Nashville, TN

ABSTRACT

Preventing Pressure Injuries in the Prone Perioperative Patient

Candi Haggard, RN CWOCN, Susan Hodgin, RN, Buffy Lupear, CRNA, Sheena M Weaver, M.D, Letha Mathews, M.D.

Purpose:

The purpose of this quality improvement project is to continually reduce the incidence of developing pressure injuries of all prone patients in the OR.

Background:

The risk of developing a pressure injury during neurosurgery is substantial. Nationally, pressure injuries related to prone position in surgery is 36%. It is known that pressure for prolonged periods, leads to ischemia induced damage. Length of surgery, prolonged prone position, and drooling during surgery put neurosurgical patients at increased risk. The development of pressure injuries was causing increased costs and often times increased LOS. We implemented a practice change in 2013 to prevent these pressure injuries from developing. Since 1/2014 to 9/6/2017, there were 4,310 prone patients that were followed.

Methods:

Five-layer self- adherent absorbent foam bordered dressings were applied on all patients undergoing prone neurosurgery/orthopedic surgery. The foam dressing was applied to the chin, forehead, chest and iliac crests 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.

Results:

Data were collected on 4,310 patients from 1/2014-9/6/2017. The average time spent in the prone position was 5.5 hours with the max being 28 hours. 34 patients developed pressure injuries including stage 1’s and 2’s as noted on Post-op Day1. Some of these 34 patients had multiple pressure injuries. The patients who developed HAPI’s were at in increased risk due to obesity and increased length of surgery.

Conclusion:

Application of five-layer self- adherent absorbent foam bordered dressings proved effective in preventing pressure injuries. Therefore, we continue to provide quality of care to all prone patients.

CS09 Preventing Pressure Injuries in the Prone Perioperative Patient