Perioperative Pressure Injuries: Protocols and Evidence-Based Programs for Reducing Risk

‐

Conclusion

In 2010, over 51 million surgeries were performed in the United States (Centers for Disease Control and Prevention, 2015). If the rate of surgical pressure injuries is assumed to be 15% (the average of incidence rates found in the literature) (Chen, Chen, & Wu, 2012), more than 7 million individuals could acquire a pressure injury during a surgical procedure in 2016 alone.Scott-sidebar

Reducing HAPI in the OR begins with educating staff and improving communication. A strategic plan that addresses the challenges and barriers to strengthening outcomes can reduce waste, conserve valuable resources, and mitigate patient harm. By implementing the strategic protocols and programs described above—including identifying at-risk patients, implementing the interventions in the OR skin bundle, and putting in place a PPIPP—organizations can help improve patient safety and strive for the ultimate goal of zero patient harm.

 

Acknowledgement 

Editorial support was provided by Jani Bergan, MA, of W2O Group, on behalf of Getinge Group, a leading global provider of innovative solutions for operating rooms, ICUs, hospital wards, and sterilization departments, as well as for elder care and life science companies.

Susan M. Scott is the patient safety quality improvement educator at the University of Tennessee Health Science Center, College of Medicine, Office of Graduate Medical Education in Memphis. At the university, she serves as an affiliated staff member at the Center for Health Systems Improvement, College of Medicine, and as a clinical instructor in the College of Nursing. Scott is also a clinical consultant and speaker for Sage Products, Inc. She may be contacted at scotttriggers@gmail.com, sscott38@uthsc.edu, and @scotttriggers on Twitter.

 

References

American Academy of Nursing. (2016). The Perioperative Pressure Injury Prevention Program. [Raise the Voice]. Retrieved June 16, 2016, from http://www.aannet.org/edge-runners–perioperative-pressure-ulcer-prevention-program.

Aronovitch, S., Wilber, M., Slezak, S., Martin, T., & Utter, D. (1999). A comparative study of an alternating air mattress for the prevention of pressure ulcers in surgical patients. Ostomy Wound Management, 45(3), 34–44.

Association of periOperative Registered Nurses. (2015). Guideline for positioning the patient. In Guidelines for perioperative practice. Denver, CO: Author.

Association of periOperative Registered Nurses. (2016). Prevention of perioperative pressure ulcers tool kit. Retrieved from https://www.aorn.org/guidelines/clinical-resources/tool-kits/prevention-of-perioperative-pressure-ulcers-tool-kit

Black, J., Fawcett, D., & Scott, S. (2014). Ten top tips: Preventing pressure ulcers in the surgical patient. Wounds International Journal, 5(4), 14–18.

Braden, B., Bergstrom N., & Ball J. (2016). Prevention Plus: Home of the Braden Scale. Retrieved from http://www.bradenscale.com/index.htm.

Brem, H., Maggi. J., Nierman, D., Rolnitzky, L., Bell, D., Rennert, R., … Vladeck, R. (2010). High cost of stage IV pressure ulcers. American Journal of Surgery, 200(4), 473–477.

Centers for Disease Control and Prevention (2015). National Hospital Discharge Survey. Retrieved from http://www.cdc.gov/nchs/nhds.htm.

Chen, H., Chen, X., & Wu, J. (2012). The incidence of pressure ulcers in surgical patients of the last 5 years. Wounds, 24(9), 234–241.

Cox, J. (2013). Pressure ulcer development and vasopressor agents in adult critical care patients: A literature review. Ostomy Wound Management, 59(4), 50–54, 56–60.

Feuchtinger, J., Bie, R. D., Dassen, T., & Halfens, R. (2006). A 4 cm thermoactive viscoelastic foam pad on the operating room table to prevent pressure ulcer during cardiac surgery. Journal of Clinical Nursing, 15(2), 162–167.

Fred, C., Ford, S., Wagner, D., & Vanbrackle, L. (2012). Intraoperatively acquired pressure ulcers and perioperative normothermia: A look at relationships. AORN Journal, 96(3), 251–260.

Lindgren, M., Unosson, M., Krantz, A. M., & Ek, A. C. (2005). Pressure ulcer risk factors in patients undergoing surgery. Journal of Advanced Nursing, 50(6), 605–612.

Lyder, C. H., & Ayello, E. A. (2008). Pressure ulcers: A patient safety issue. In Patient safety and quality: An evidence-based handbook for nurses (Chapter 12). Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2650/.

Lyder, C. H., Wang, Y., Metersky, M., Curry, M., Kliman, R., Verzier, N. R., & Hunt, D. R. (2012). Hospital-acquired pressure ulcers: Results from the National Medicare Patient Safety Monitoring System Study. Journal of the American Geriatrics Society, 60(9), 1603–1608.

Man, S. P., & Au-Yeung, T. W. (2013). Hypotension is a risk factor for new pressure ulcer occurrence in older patients after admission to an acute hospital. Journal of the American Medical Directors Association, 14(8), 627.

Martinez, S., Braxton, C., Helmick, R., Awad, S., & Lara-Smalling, A. (2014, May). Sustainability of a hospital acquired pressure ulcer prevention bundle in surgical patients. Presented at the Surgical Infection Society 34th Annual Meeting, Baltimore, MD.

McInnes, E., Jammali-Blasi, A., Bell-Syer, S. E. M., Dumville, J. C., Middleton, V., & Cullum, N. (2015). Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD001735.pub5.

Minnesota Hospital Association. (2013, March). Pressure ulcer prevention in the O.R. Recommendations and guidance. Retrieved from https://www.mnhospitals.org/Portals/0/Documents/ptsafety/skin/OR-pressure-ulcer-recommendations.pdf.

Munro, C. A. (2010). The development of a pressure ulcer risk-assessment scale for perioperative patients. AORN Journal, 92(3), 272–287.

National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, & Pan Pacific Pressure Injury Alliance. (2014). Prevention and treatment of pressure ulcers. Clinical practice guidelines. Perth, Australia: Cambridge Media.

Nixon, J., McElvenny, D., Mason, S., Brown, J., & Bond, S. (1999). A sequential randomized controlled trial comparing a dry viscoelastic polymer pad and standard operating table mattress in the prevention of post-operative pressure sores. Journal of Nursing Studies, 35, 193–203.

Pham, B., Teague, L., Mahoney, J., Goodman, L., Paulden, M., Poss, J., … Krahn, M. (2011). Support surfaces for intraoperative prevention of pressure ulcers in patients undergoing surgery: A cost-effectiveness analysis. Surgery, 150(1), 122–132.

Putnam, K. (2016). Minimizing pressure ulcer risk for surgical patients. AORN Journal, 103(4), 7–9.

Russell, J., & Lichtenstein, S. (2000). Randomized controlled trial to determine the safety and efficacy of a multi-cell pulsating dynamic mattress system in the prevention of pressure ulcers in patients undergoing cardiovascular surgery. Ostomy Wound Management, 46(2), 46–51.

Schoonhoven, L., Defloor, T., & Grypdonck, M. H. (2002). Incidence of pressure ulcers due to surgery. Journal of Clinical Nursing, 11(4), 479–487.

Scott, S. (2015). Progress and challenges in perioperative pressure ulcer prevention. Journal of Wound, Ostomy and Continence Nursing, 42(5), 480–485.

Scott, S. (2016). Creating a strategic plan for perioperative pressure ulcer prevention. AORN Journal, 103(4), 13–14.

Scott, S., & Hector, M. (2001, February). A Certified Wound, Ostomy, and Continence Nurse (CWOCN) approach to pressure ulcer, prevention and treatment: Complication and cost reduction. Poster presented at National Pressure Ulcer Advisory Panel 7th National Conference, Pressure Ulcer Prevention: From Research to Practice, Washington, D.C.

Wake, W. T. (2010). Pressure ulcers: What clinicians need to know. The Permanente Journal, 14(2), 56–60. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912087/.

Waters, T., Daniels, M., Bazzoli, G., Perencevich, E., Dunton, N., Staggs, V., … Shorr, R. I. (2015). Effect of Medicare’s nonpayment for hospital-acquired conditions: Lessons for future policy. JAMA Internal Medicine, 175, 347–354.