We've added that skin assessment to our SBAR (situation, back-
ground, assessment, recommendation) handoff communication, so
now when patients reach the OR, the nurses there are made aware of
any and all skin-related concerns. Then, in the OR, depending on the
procedure, we add more foam dressing and gel pads, especially if
patients are in the prone position. We make sure to pad their faces,
their chests, their hips and their knees.
When the procedure ends, the head OR nurse calls the PACU and
gives the report to the charge nurse, but anesthesia actually transports
the patient to the PACU. So, if any additional potential skin issues have
been identified during the procedure, anesthesia tells the PACU nurses
what concerns we had and how we treated them, as well as what the
patient position was and how long the surgery lasted.
The PACU nurses then monitor the situation and report to the pri-
mary nurse regarding skin findings or other concerns, as well as any
prevention plan of care implemented while the patient is in the PACU.
Feedback loop
Before we implemented our new procedures, patients would leave the
OR with a potential issue, but we wouldn't necessarily find out how it
turned out — whether the issue was resolved or worsened. Now,
we've also developed a strong partnership with the caretakers who do
follow-up evaluations, so the all-important feedback loop continues
for several days.
That way, if a problem develops, we can address what we might
have been able to do better or differently. As part of the process,
we're continually evaluating different types of positioning equipment
to see whether certain products or approaches work better with par-
ticular patients.
It's an elaborate approach, and at first, we got a little bit of push-
5 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J A N U A R Y 2 0 1 9
