protocols for treatment of Stage 1 and 2 pressure
injuries, as well as a wound care consult service
to respond in the event of a more severe injury. If
none exist, document that their skin was normal.
6. Educate your staff
Hard data for inpatient hospital stays shows that
approximately 35% of hospital-acquired pressure
injuries begin on the OR table. We know this
because pressure injuries typically become visible
about 72 hours after they're caused, and we can
track where the hospitalized patients were three
days before the wound became apparent. No such
data exists for outpatient surgery because patients
are home before a wound is noticeable. In both are-
nas, however, many OR teams have very little idea
that pressure injuries can start in the OR.
If this is the case in your facility, have wound-
care specialists show cases of pressure injuries —
complete with medical records and photos — to the
OR team. Highlight for staff how these injuries are
linked directly to the OR. Consider developing OR-
specific educational tools that include these case
studies, as well as prevention strategies.
Be sure to equip your surgical team with skin-
safe equipment such as mattress pads for your OR
tables and patient positioning devices.
7. Follow the standards
There are national guidelines for pressure injury
prevention — and these guidelines should be fol-
lowed to the letter. A copy of these recently updat-
ed evidence-based practices is available from the
3 2 • 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 2 0
National Pressure Injury Advisory Panel
(npiap.com). Several years ago, the Wound,
Ostomy and Continence Nurses Society (WOCN)
began collaborating with the Association of
periOperative Registered Nurses (AORN) to high-
light and bring awareness of pressure injuries
occurring in the OR. This collaboration resonated
with AORN and, as a result, its published guidelines
now include preventing pressure injuries as an addi-
tional reason to position patients properly. All trust-
ed, relevant organizations are now following suit
because everyone recognizes that most pressure
injuries are preventable and that many happen as a
result of inappropriate practices. Following national
guidelines is one sure way to prevent hospital-
acquired pressure injuries.
An unacceptable outcome
Pressure injuries are a patient-safety issue, a quali-
ty-of-care issue and a patient-satisfaction issue —
and the majority of them are largely avoidable.
We never want anyone who was under our care to
leave in worse shape than when they came in. It
took three months for the buttocks wound on the
woman who underwent the jaw surgery to heal. As
caregivers, it's simply unacceptable to prolong
unnecessary pain and suffering like that. It's horren-
dous for the patient and exposes the facility to a
potentially costly legal entanglement.
OSM
Ms. Creehan (sue.creehan@live.com) is an independ-
ent wound nurse consultant and the former program
manager of the Virginia Commonwealth University
Health Wound Care Team in Richmond, Va.
DEVICE DAMAGE Poorly placed items can cause pressure injuries as easily as poor positioning. In this case, a blanket placed under a child in the prone position
resulted in a chest injury.
