injuries so we can document and
address them before surgery. We
changed our policy so that any
patient in a procedure lasting 3
hours or more is considered high
risk, as well as anyone with a score
of 16 or below on the Braden Scale
for Predicting Pressure Injury Risk
(osmag.net/M3BaHo). Those with
a BMI of 19 or below, or 35 and
above, are also considered high
risk. Once we identify patients as
high risk, we ask them to wear a
bright green bouffant cap instead
of our usual blue ones. We also
place a green placard in their
charts, so it's clear to all staff which
patients are at heightened risk.
• Positioning aids. If a patient has an existing injury, we use a 5-
layer silicone border dressing to help protect the delicate area of skin.
We also apply heel protectors to high-risk patients in the supine posi-
tion, and keep a range of prophylactic foam dressings, gel-based pads
and fluidized positioning devices available on our pressure injury cart
to use on patients considered high risk.
We've made equipment improvements in response to injuries that
occurred in the past. In January 2017, a patient suffered a pressure
injury on the occiput. We reviewed the incident and determined the
injury was roughly the same size and shape as the donut pillow we
were using. So we swapped the pillow out for a fluidized positioner,
which is a specialized modality that offloads any pressure points on
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 • O C T O B E R 2 0 1 9
• EXTRA PADDING Surgical teams need easy access to a
variety of positioning aids to help prevent skin breakdown in
vulnerable areas.
Pamela
Bevelhymer,
RN,
BSN,
CNOR