monitor. Areas on the patient that appear red or
orange are under too much pressure. If they appear
yellow or green, there's little to no risk of a pres-
sure injury. When you locate red and orange spots,
you can pad the patient in those areas, or place bet-
ter padding on those parts of the bed.
If a high percentage of your patients return to
surgeons' offices with deep tissue injuries a couple
of days after their surgeries or report deep tissue
issues during post-op calls with nurses, you know
improvements must be made to how you protect
sensitive areas. In that instance, you can map indi-
vidual patients before procedures begin to locate
and protect their specific hot spots.
5 6 • 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 • A U G U S T 2 0 2 0
Raising awareness
Your clinical educator should
make sure staff understand the
general risk factors that con-
tribute to pressure injures and
provide constant reminders about
injuries that can occur while
patients are in the prone position.
Education only takes you so far,
however. If you become aware of
a prevalence of pressure injuries
and educate staff about them, pre-
ventative measures should be
operationalized in your facility's
documentation system.
Photographs of bodies in all
the major surgical positions can
be embedded in your facility's
electronic medical record, along
with the pressure-injury hot spots
for each position. Nurses can plug
the procedure that's about to take
place into the medical record and
have the appropriate image pop
up, along with the probable pres-
sure ulcer locations for that posi-
tion. If the patient's skin condi-
tion in those areas is poor, extra
padding can be applied for addi-
tional protection.
Hospitals that track pressure
injuries show that 40% originate in
the OR. That information often gets lost because
injuries often don't appear until well after surgery.
While that percentage might not be as high in the
outpatient arena, your staff can't assume there's no
risk of pressure injuries occurring when patients are
placed in the prone position. Assumptions like that
make you ripe for lawsuits. Not padding a patient's
face is not a good defense in a case filed by a patient
who decided to have an elective back surgery and
walked out with a visible wound on their chin.
OSM
Dr. Black (jblack@unmc.edu) is a professor in the
College of Nursing at the University of Nebraska
Medical Center in Omaha, Neb.
ON THE SURFACE Specialty designed spine tables improve access to the surgical site and can help to protect patients
from pressure-related harm.
Joyce
Black,
PhD,
RN,
CWCN,
FAAN
