The protocols are very similar to
the prevention program we
already had in place. If a patient in
pre-admission testing has a BMI
exceeding 40 or is under 18, the
staff will flag them as a possible
high-risk patient. They then email
both me and the director of the
surgery center. We discuss the
case together and decide if there's
any chance that the patient could be in the OR for more than 3 hours.
If the answer is yes, we perform similar pre-, intra- and post-operative
steps that we take in our medical center's main ORs, including con-
ducting a head-to-toe skin assessment with documentation preopera-
tively, placing the patient on gel pads and using viscoelastic padding
on the OR table.
Intraoperatively, we perform another skin assessment and reposi-
tion the patient to protect tender areas, if needed, and use a five-lay-
ered silicone border dressing to protect the heels and sacrum. Post-
operatively, we perform a final skin assessment before discharge.
During the post-op phone call, if the patient had any injuries or red-
ness assessed in PACU, the nurses ask additional questions and
refer them to their physicians for further follow-up.
In this surgery center model, we've had dozens of patients flagged
because of their BMI, but because of the length of surgery, we have
only had 6 patients go through the full pressure injury protocol. We
also had great buy-in from staff at the surgery center; 2 RNs had trans-
ferred there from the main ORs, so they were used to the program.
We also held in-service classes for staff, and had vendors come in to
show the team how to use preventative dressings and positioning
4 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 • O C T O B E R 2 0 1 9
• SKIN IN THE GAME Pre-op assessments identify at-risk
patients who need added layers of protection during surgery.
Pamela
Bevelhymer,
RN,
BSN,
CNOR
