patients throughout their length of stay, whether they're in ambulatory
surgery or one of our critical care or interventional units. These initia-
tives included:
1. Staff education and communication. Prevention begins with
knowing the risk factors and how to effectively manage them. Who's
most at risk? Broadly speaking, any patient in a procedure lasting 3
hours or more should be considered high risk, as should anyone with
a score of 16 or below on the Braden Scale for Predicting Pressure
Sore Risk (osmag.net/ZMs6Cf) and a body mass index of 19 and
below or 35 and above.
Resources and toolkits from the Association of periOperative
Registered Nurses and the Agency for Healthcare Research and
Quality can help you teach pre-op and post-op nurses the ins and outs
of prevention and treatment, including how to identify the telltale
signs of a pressure injury and how to stage an injury accurately. These
tools can also provide guidance on which parts of the body will be
vulnerable to pressure injuries based on the patient's anticipated sur-
gical position. After all, if you don't take the time to educate the staff
about surgical positions, how will they know how the pressure points
differ between, say, lithotomy position and prone position?
2. Pre-op skin evaluation. Through the implementation of this
head-to-toe assessment, we discovered that as many as 25% of
patients are at risk of developing a pressure ulcer, which was higher
than we anticipated. It's also helped us identify existing pressure
injuries so we can document and address them before surgery. If a
patient comes in with an existing injury but it's not assessed and doc-
umented with a pre-op skin evaluation, we have to assume it was gen-
erated in the OR. In addition to a full visual assessment, I ask the
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