O C T O B E R 2 0 1 5 O U T P A T I E N TS U R G E R Y. N E T 5 3
collaborate to remind nurses how to use evidence-based practices, for which
there is a wealth of supporting literature. Try a case review of a patient who suf-
fered a perioperative injury. Talking about what went wrong, and what could
have prevented it, is an interactive and effective way to keep patients safe.
3. Soften the surface
Only in the past 10 years or so have pressure injuries received the preventive
attention they deserve. The areas of chief concern are the bony prominences, in
particular the sacrum, coccyx and buttocks (the anatomy most commonly affect-
ed by pressure injuries); the heels (often overlooked, but at risk among patients of
all ages); and the back of the head (where damage can be concealed by the hair).
Use soft, silicone, multi-layered sacral dressings to protect patients against fric-
tion and shear during transfers and pressure while they're positioned for surgeries.
The suspension of the heels is another critical intervention. While this can be
accomplished through the use of stirrup boots and other devices, it doesn't require
large investments in table accessories.
The National Pressure Ulcer Advisory Panel's clinical practice guideline on
prevention and treatment (osmag.net/2PdGeQ) recommends placing pillows or
foam cushions beneath the legs to "float the heels" and eliminate pressure on
them entirely. This also creates a slight flexion in the legs and knees.
Additionally, many inexpensive positioning devices — including gel-filled,
donut-shaped cushions — can assist in redistributing pressure beneath the back
of the head.
A supportive surface is of utmost importance in preventing perioperative
injuries. Patient safety depends not just on how you position their arms and
legs, but the surfaces they're placed on.
While the NPAUP's guideline doesn't name specific products, it recommends
the use of pressure redistribution pads on OR tables. Redistribution, not reduc-
tion, is the key here. Consider, for example, foam padding. It's ideal for prevent-
