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 sur-
gical patients and PIs —
namely, 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 depart-
ment. 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 assessments. 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 sur-
gery. 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 effec-
tive for pre-op, perioperative and PACU skin risk
assessments. Instead, they imple-
mented the CMunro Scale (osmag.net/RjwK4V).
How it works: Pre-operatively, a nurse uses this
easy-to-remember acronym to quickly gather infor-
mation on 6 risk factors: comorbidities and current
health status, mobility, age (over 60 is high risk),
nutritional condition, recent weight loss and BMI.
"Unlike the Braden Scale or the full Munro Scale,
we're not looking to generate a score to determine
the patient's PI risk level," says Ms. Kooiker. "We
simply want to identify if the patient is at risk."
To save time, it's a focused assessment. Nurses
don't examine the whole body, but rather the parts
that will be under stress during surgery, she says.
"We take the necessary precau-
tions, including applying foam
2 4 • 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
• AT A GLANCE This handy badge card
reminds Metro Health Hospital clinicians of
the CMunro Scale and comorbidities.
There's this idea that PIs aren't an issue in the
outpatient world. I think that's because the
patient is in and out in under a day, and the
center often never sees that patient again.
They largely aren't aware of subsequent PIs.
— Heather Kooiker, MSN, RN, CNL, CRNFA
