Outpatient Surgery Magazine

2 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 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 practition- ers. From January 2014 to September 2017, they fol- lowed 4,310 prone patients. The task force trialed new products and imple- mented positioning workshops for OR nurses and anesthesia providers. It developed standard posi- tioning competencies for all staff, including resi- dents and attendings, increased equipment par lev- els and performed root cause analyses on all OR- acquired PIs to identify areas of improvement. They implemented numerous potential preventive meas- ures, 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 pro- cedure table. • They began multidisciplinary positioning work- shops and competencies for all neurosurgical OR staff, including nursing, anesthe- sia and surgeons, to minimize positioning variability. • They developed a data collec- tion tool to standardize their fol- low-up and documentation. The early returns are promis- ing. Vanderbilt has lowered its 7% incidence of OR-acquired PIs for the prone position in 2015 to less than 1%, says Ms. Haggard. "If I had to pick one PI preven- tion area that's often overlooked, it's the moisture component," she says. "We know moisture makes skin less tolerant and can increase PI risk. In the OR, perspiration, drainage or saliva in the prone patient are often overlooked as contributing factors." A good streak The perioperative areas at Dartmouth Hitchcock Medical Center in Lebanon, N.H., recently went 10 months with no PIs. Megan Miller, MSN, APRN, AGACNP-BC, CWON, of the department of wound care services, outlines the keys to their success. It started with a renewed focused on pre-op skin assessments, with preventative dressings applied based on surgery type. In the OR, they standardized support surfaces and replaced them at regular inter- vals. They equipped tables with a better offloading surface while not interfering with operations. They charged anesthesia with adjusting the position of the patient's head. And in PACU, the focus was on quickly offloading pressure on the sacrum, buttocks and heels. Dartmouth Hitchcock also shared data on PIs with surgical services. "We noticed that periopera- tive services were disengaged about PIs," says Ms. Miller. "We hadn't been giving them accurate and timely data about PI incidents, so PIs weren't a con- cern for them." As you can see, preventing PIs isn't as burden- some as it sounds. You just need to make it a rou- tine part of your culture. OSM • PRESSURE-SENSITIVE AREAS In the prone position, pressure ulcers frequently develop on the forehead, cheek, female breasts, male genitalia, ankles and toes. An overlooked risk? Drooling. Pamela Bevelhymer, RN, BSN, CNOR

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