Outpatient Surgery Magazine - Subscribers

Hip With the Times - July 2017 - Outpatient Surgery Magazine

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

Issue link: http://magazine.outpatientsurgery.net/i/845806

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Page 60 of 168

inconsistency," says Ms. Digneo, the facility's nurse director. "Multiple surgeons and different circulators were using different positioning practices. Of course we also wanted to decrease the potential for hav- ing pressure ulcers develop during surgery." It wasn't something her staff had been having a problem with, and she wanted to keep it that way. A team made up of RNs, surgical techs, nursing aides and a CRNA ended up recommending several changes to protect bony promi- nences and vulnerable pressure points: • Provide ankle support. The team realized that patients on their backs were vulnerable to pressure ulcers, because their ankles were being allowed to rest on OR tables and beds and weren't being elevat- ed. "That was a change in practice," says Ms. Digneo. "We now have gel supports that we place under patients' ankles to take their feet off the bed." • Look out for lithotomy. Patients positioned in stirrups are poten- tially vulnerable in a couple of ways, the team found. One solution was to equip tables with larger boots that accommodate, support and protect the ankles and calves of larger patients placed in the stirrups, eliminating the potential for spillover that could result in pressure sores. Staff members were also reminded about the dangers of hyper- extension and nerve injuries. • Prevent slippage. The team also noted that patient warming sometimes caused patients to perspire, which made them more likely to slide when in the Trendelenburg position and potentially experi- ence shearing. Plenty of pads, restraints and bolsters are designed to secure patients in Trendelenburg, including an underbody pad that Ms. Digneo says helps absorb perspiration and keep patients from slipping and sliding. • Avoid friction injuries. The team also decided against using foam J U L Y 2 0 1 7 • O U T PA T I E N T S U R G E R Y. N E T • 6 1

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