4 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A U G U S T 2 0 1 9
Not our
problem
The general belief
at Metro Health
Hospital in
Wyoming, Mich.,
was that PIs were
an inpatient prob-
lem, not a surgical one. But the more they studied it, they uncovered
significant statistical links between surgical patients and PIs — name-
ly, a large number of patients who presented with PIs during or after
inpatient stays had been operated on in the hospital, says Heather
Kooiker, MSN, RN, CNL, CRNFA, clinical nurse leader of surgical
services, who last year rolled out an evidence-based PI bundle for the
surgical department. It was, she says, a culture-changer for the 205
pre-op, perioperative and post-op nurses.
"They hadn't been expected to perform full head-to-toe skin assess-
ments. They reported it wasn't part of their workflow and there
wasn't time for it," says Ms. Kooiker. "That led to many at-risk patients
not being identified upon admission or during surgery. We needed to
efficiently work skin assessment into their routine."
Metro Health decided the Braden Scale, while great for inpatient
skin assessments, isn't as effective for pre-op, perioperative and PACU
skin risk assessments. Instead, they implemented the CMunro Scale
(osmag.net/RjwK4V). How it works: Pre-operatively, a nurse uses this
easy-to-remember acronym to quickly gather information on 6 risk
factors: comorbidities and current health status, mobility, age (over 60
• AT A GLANCE This handy
badge card reminds Metro
Health Hospital clinicians of the
CMunro Scale and comorbidities.
