3 6 S U P P L E M E N T T O O U T P A 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 6
manufacturer's design. Neither a blanket nor a sheet offers pressure reduction.
Using either one "sets nurses up for failure in protection and may impose a lia-
bility."
6. Form a skin integrity team
The best defense against inappropriate use? As surgeries become more com-
plex, Ms. Hensell recommends convening a committee to continuously evaluate
products intended to help prevent injuries.
Forming a skin integrity team is another approach to foster safe patient posi-
tioning. Ideally, the team would consist of nurses in various roles — from wound
care to front-line staff, as well as floor nurses who collect data post-operatively,
says Ms. Hensell, who is in the process of assembling such a team.
Because pressure ulcers tend to appear 1 to 5 days after surgery, too often
they're attributed to the floor nursing staff, whereas the more likely culprit is
deep pressure applied in the operating room, she says. A dressing can be left in
for as long as 5 days after the procedure and is very helpful in preventing ulcers
on the heels or buttocks.
7. Protect elderly patients
Despite your diligence, acuities and comorbidities tend to escalate along the
age spectrum. Be on the lookout for fragile skin, which is more common in
the elderly. If it's thin or you notice bandages or skin tears, those are red
flags for potential injuries, says Mr. Klev. It's also better to err on the side of
asking too many questions rather than not asking enough questions. Before
any procedure, he suggests inquiring: Have you had any joint or back surger-
ies? Do you feel any pain in those areas? And do you currently have open
sores? With safe practices, elderly patients tolerate positioning in the OR
well. Earlier this year, Mr. Klev recalls, a 95-year-old female patient success-
fully underwent a Mohs repair for skin cancer without incurring any injuries
or pressure sores.
