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Healing is Coming - February 2021 - Subscribe to 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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T he two-inch red circle on the patient's sacrum was unmistakable. A PACU nurse noticed the deep tissue injury during a post-op assessment and called over to pre-op to see if one of her col- leagues had documented the patient's skin condi- tion before surgery. No one had. The 51-year-old male patient with a BMI of 44 had undergone a left distal open reduction and internal fixation, an out- patient procedure that typically takes 90 minutes to complete, but this case had unexpectedly lasted more than three hours. All told, including time spent in pre-op, the patient was supine on a stretch- er for five hours. "We didn't have a pressure injury prevention pro- gram in place at our on-campus surgery center, so a pre-op baseline skin assessment wasn't done," says Diane Kimsey, MSN, MHA, RN, CNOR, CMLSO, WTA, perioperative educator at Einstein Medical Center Montgomery in East Norriton, Pa. "At the time, we weren't sure if the patient presented with the injury or had acquired it during surgery." Many surgical nurses float between Einstein's inpatient ORs and its ASC, so they're familiar with the comprehensive pressure injury prevention pro- gram in place at the main hospital. "We had to determine what protocols could provide the same level of protection for patients in the ambulatory setting," says Ms. Kimsey. She huddled with Bryan Panetta, RN, manager of the hospital's short procedure unit and operating room, and developed a straightforward pressure injury risk-reduction strategy based on a three-hour limit because "evidence shows skin can break down on patients who remain in a static position for that long," says Mr. Panetta. • Identifying high-risk patients. The nurse who reviews charts several days before scheduled proce- dures flags patients with BMIs under 19 and over 40 — individuals who are obese and underweight are at increased risk for skin breakdown — and sends an email including the patients' names, dates of sur- gery and BMIs to Ms. Kimsey and Mr. Panetta. "We then determine if there's any possibility of the patient being on the surgical table or stretcher chair for longer than three hours," says Ms. Kimsey. Mr. Panetta knows how long scheduled proce- dures should last, but also taps into his working knowledge of how the surgery center runs to help make the decision. For example, he knows cases with surgeons who are more — ahem — deliberate than their colleagues have a chance to go over the allotted time on the schedule. He's aware that distal open reduction and internal fixations —the proce- dure that launched the hospital's risk-reduction bundle — require instrumentation that takes a long time to set up and complex foot reconstructions can last longer than expected. If there is little to no possibility that a patient will F E B R U A R Y 2 0 2 1 • O U T P A T I E N T S U R G E R Y . N E T • 2 9 Dan Cook | Editor-in-Chief Rethinking Pressure Injury Prevention A surprising skin lesion led to the launch of a risk-reduction program for outpatient procedures. SKIN IN THE GAME Safe patient positioning demands staff buy-in and excellent communication among all members of the patient care team. Diane Kimsey

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