Outpatient Surgery Magazine - Subscribers

Healing is Coming - February 2021 - Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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be on a table or stretcher chair for more than three hours, no action is taken. Patients who are expect- ed to remain on either surface beyond the three- hour limit are placed in the risk-reduction bundle, and the perioperative team is notified about the added protection these patients require. • Preoperatively. A green placard is placed in the charts of high-risk patients to alert pre-op nurs- es that they must conduct full-body assessments to look for pre-existing skin injuries and document the results in the hospital's EMR. If skin issues exist, they are assessed, dressed if applicable and documented in the EMR. High-risk patients wear a green bouffant to alert other members of the care team that steps are needed to protect the patient from harm. 3 0 • 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 • F E B R U A R Y 2 0 2 1 You might think your staff doesn't need to be overly concerned with pressure injury prevention because patients who undergo outpatient procedures are relatively healthy and have fairly normal BMIs and low ASA scores. Think again. "Pressure injury risk in the outpatient setting is an underreported and underrated problem," says Diane Kimsey, MSN, MHA, RN, CNOR, CMLSO, WTA, peri- operative educator at Einstein Medical Center Montgomery in East Norriton, Pa. "Your entire care team must ensure appropriate skin assessments take place, and follow protocols to identify high-risk patients and apply extra protection to their skin to protect it from harm." Be sure to pay extra attention to these high- risk areas, based on AORN's Pressure Injury Prevention Toolkit, when positioning and padding patients before surgery. • Supine. Protect the occiput, scapulae, elbows, thoracic vertebrae, lumber area, sacrum/coccyx, buttocks and heels. • Prone. Pad the forehead, eyes, ears and chin. Also place added protection on the chest or breasts, iliac crest, genitalia, knees, shins, dorsa of the feet and toes. • Lateral. Address the side of the face, shoul- der on the vulnerable side, and the dependent axilla, hip, leg, knee, ankle and foot. • Lithotomy. Do not extend the buttocks over the break of the bed. Protect the lateral aspect of the upper fibula. Apply boot stirrups to support the legs and reduce the stretching of nerves. Pad the occiput, scapulae, elbows, thoracic vertebrae, lumber area, sacrum/coc- cyx, buttocks, and lateral aspects of the legs and heels. • Beach chair. Pad the occiput, scapulae, ischial tuberosities, backs of the knees and the calcaneus. • Trendelenburg. Shear injuries can result from sliding, so secure the patient without using shoulder braces, which can cause brachial plexus nerve injury, or chest straps, which can inhibit proper respiration. Placing a protective pad designed to prevent slippage under the patient is an effective option. Additionally, place added protection at the occiput, scapula, arms, elbows, vertebra, lumbar area, sacrum/coccyx, buttocks and heels. —Dan Cook ADDED PROTECTION Pressure Points by Position Pamela Bevelhymer

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