pre-op phase, you simply have to remember the acronym of the
first word, CMUNRO, to assess the six key factors that put a
patient at risk for an injury:
C (co-morbidities, current status)
M (mobility)
U (under or over age 60)
N (nutrition)
R (recent weight loss)
O (overweight).
In addition, nurses only examine the specific body parts that will
be under stress during the procedure, as opposed to a full patient
assessment.
Of course, there are still plenty of fast-paced, high-volume out-
patient facilities that don't implement any type of risk assessment
because they feel the patients are only in surgery for a short peri-
od of time. As the scale above shows, time is far from the only
factor that leads to a pressure injury.
Intervene as needed
Pressure injuries often occur when staff fail to intervene and take
specific measures to protect patients' vulnerable areas. I recently
had a nurse say to me, "Heather, my patient did really well during
the case, but in recovery she was complaining about pain in her
heels. What do you think is happening there?" The first thing I
asked was whether she floated the patient's heels off the bed. Turns
out she didn't, because she was unaware of the new evidence that
shows egg crate foam to be ineffective. This was a seven-hour case
where the patient was in supine position. The PI bundle I put
together following AORN recommendations and evidence-based
practice includes a number of position-specific protective measures
A P R I L 2 0 2 0 • O U T PA T I E N T S U R G E R Y. N E T • 4 9
