• pressure for prolonged periods leads to ischemia-induced damage;
• length of surgery and drooling during surgery put neurosurgical
patients in particular at increased risk (Vanderbilt's baseline monthly
PI rate in the neurosurgical population for 2015 was 8% to 10%).
There were numerous problems with their existing process, says
Ms. Haggard. They had no consistent method for tracking — or pro-
viding feedback to providers — when a patient developed a PI. And
they had variations in their positioning practices for neurosurgical
patients in the prone or park bench positions.
They developed a Perioperative Pressure Injury Prevention Task
Force comprised of the quality department, WOC nurses, anesthesia,
OR nursing staff, OR managers, educators and nurse practitioners.
From January 2014 to September 2017, they followed 4,310 prone
patients.
The task force trialed new products and implemented positioning
workshops for OR nurses and anesthesia providers. It developed stan-
dard positioning competencies for all staff, including residents and
attendings, increased equipment par levels and performed root cause
analyses on all OR-acquired PIs to identify areas of improvement.
They implemented numerous potential preventive measures, says Ms.
Haggard.
• For neuro and ortho patients, they applied 5-layer, self-adherent
and absorbent foam-bordered dressing on the chin, forehead, chest,
iliac crests and any other tissue coming in contact with the procedure
table.
• They began multidisciplinary positioning workshops and compe-
tencies for all neurosurgical OR staff, including nursing, anesthesia
and surgeons, to minimize positioning variability.
• They developed a data collection tool to standardize their follow-
up and documentation.
4 6 • 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
