4. Smooth the surface. If a patient will be in a hospital bed before
his outpatient procedure, smooth wrinkles out of the sheets, as these
can add excess pressure on the skin. Also, limit raising the head of
that bed more than 30 degrees, as this can cause the body to be pulled
down by gravity while the skin remains fixed, leading to pressure
ulcer-causing shear. "If we do raise the head, we gatch the knees to
prevent the body from sliding toward the end of the bed," says Mary
Paciella, RN, MS, CCRN, ANP, ACNS-BC, PCCN, director of employee
health and wellness at Stony Brook (N.Y.) Medicine.
5. Perform a risk assessment. Before surgery, conduct a pres-
sure ulcer risk assessment using the Braden Scale for Predicting
Pressure Sore Risk (osmag.net/3oRhSC), which evaluates risk
according to 6 categories: sensory perception, moisture, activity,
mobility, nutrition, and friction/shear. "But be mindful that this scoring
system is geared toward long-term care, not surgical patients," says
Joyce Black, PhD, RN, CWCN, FAAN, member of the skin wound
advisory team at Nebraska Medical Center in Omaha, Neb. "Nurses
need to conduct their own assessment, using their clinical judge-
ment." Is surgery expected to last more than 3 hours? Is the patient
older than 62? Does the patient have a BMI of less than 19 or greater
than 40? All of these factors increase risk.
6. Assess the skin. Ask patients about previous pressure ulcers, as
the skin here is more vulnerable. Look for scars, as this tissue will be
vulnerable as well. Take note of discolored areas, or areas that are
warm, hard and spongy, as these might be early signs that a pressure
ulcer has already started to develop. Once you've identified high-risk
spots, dress them with multi-layer soft silicone dressings according to
manufacturer instructions, being sure to cover the entire area without
4 4 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A R C H 2 0 1 7
