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sure ulcers; the significance of these factors is yet to be elucidated." You need to try to understand and address those other factors, too.
Ask interested nurses in pre-op, the OR and PACU to join certified wound and ostomy care nurses on a skin care task force — ours is known as the Perioperative Pressure Ulcer Prevention (PPUP) team. The interdepartmental approach is essential because each area has a unique role in pressure ulcer prevention. Team members identify the barriers and needs of each department and become champions for change. Bringing nurses from 4 departments together for an evidence-based practice-improvement project boosts interdepartmental communication and cooperation.
2. Practice. Conduct high-level skin assessments before and after surgery. Adopt risk-assessment and skin-integrity communication tools that are handed from pre-op to the OR, and from the OR to PACU. Also train nurses in all 3 departments on how to use the Braden Scale (see "2 Patients, 2 Plans"). Use the tool to record risks and observations, and to document pressure and ulcer prevention interventions.
3. Perception. Educate your staff by providing articles from scientific journals about how ulcers form, and the best practices for prevention. Perioperative nurses want good evidence of need and concrete techniques for change, so also present in-services approximately 3 times a year, with guest speakers, hands-on practice and case studies.
At our first in-service, the coordinator of our nurse quality council presented national hospital-acquired pressure ulcer data and compared them with our statistics. Each patient who developed a pressure ulcer in our facility had a drill-down tool completed, so we could see how many patients had come to the OR before developing a pressure ulcer and how many days after the OR experience the pressure ulcer occurred, which indicated whether it was OR-acquired. It was an eye-opening presentation.
The most interactive in-service used a case study of 2 patients who developed intraop pressure ulcers while in our care. It really captured staff interest,
