Skin Integrity

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WHY IT MATTERS

ULCERS IN THE OR

THE CHALLENGE

THE SOLUTION

Practices | Research | Technology

THE SOLUTION: PRACTICES

Education and Communication Strategies

	Create a plan to monitor and track pressure ulcers developed perioperatively.
	Stay educated about new research.
	Keep the patient’s skin as dry as possible during the procedure.
	Maintain the continuum of care through communication between all departments that will have responsibility for the patient during his stay.

Assessment Strategies

Patient assessment is a constant process. Pressure ulcer prevention should begin at the time of admission and continue until the time of discharge. Below are some prevention and assessment strategies, grouped by phase of hospital stay.

		Identify at-risk patients		Know all of the equipment that will be used during the surgery.
		Assess the patient’s anatomy for bony prominences and pad them accordingly.		Employ methods of transferring the patient that will reduce or eliminate friction and shear.
		Keep the patient’s skin as dry as possible during the procedure.		Do not rub or massage skin where pressure damage has already occurred.
		Have a plan to keep the patient’s body temperature as close to normal as possible throughout the procedure.

		Check for adequate peripheral perfusion in known high pressure areas.		Ensure that there are no wrinkles in any of the surfaces on which the patients is lying.
		Specifically pad known pressure points.		Reduce skin moisture levels intraoperatively if possible.
		Maintain proper anatomical alignment when positioning the patient in the desired surgical position.

		Reposition immobile patients at least every two hours.		Consider dynamic pressure relieving devices in high risk patients.
		Note any changes in the patient’s skin.		Monitor and routinely clean incontinent patients.
		Monitor and control other environmental risk factors such as temperature and humidity.		Keep the head of the bed below 30° to reduce shearing on the patient’s sacral area.
		Provide total relief at pressure damaged areas.		Get the patient moving around soon after surgery.
		Remove extra adhesives from the patient’s skin as soon as the procedure is over.

Adapted from:
The Clinical Issue: Pressure Ulcers in the Surgical Patient.
S Shoemake, K Stoessel
Knowledge Network. Kimberly-Clark Healthcare Education

Armstrong D, Bortz P. An integrative review of pressure relief in surgical patients. AORN J 2001;73(3):645,647-8,650-3

Price MC, Whitney JD, King CA, Doughty D. Development of a Risk Assessment Tool for Intraoperative Pressure Ulcers. J Wound Ostomy Continence Nurs. 2005;32(1):19-30.