patient if he has had previous pressure ulcers, because the skin here
is more susceptible to breaking down.
3. Making at-risk patients "visible." Once you have assessed a
patient as "high risk," all stakeholders must be able to easily identify
them as such. We have high-risk patients wear bright green bouffant
caps as opposed to the standard blue. We also place a green "alert"
placard in each high-risk patient's chart, so even if communication
somehow breaks down between departments, it's clear which patients
are at risk.
4. Dressings and positioning aids. All our high-risk patients
receive heel protectors. We prophylactically pad patients with low
BMI on such bony prominences as the heels and sacrum. In the case
of an existing injury, we'll use a gentle dressing with a silicone border
as a protective barrier.
We keep a dedicated "skin cart" in the pre-op area, complete with a
range of prophylactic foam dressings and a "gel cart" in the OR with
gel-based pads and fluidized positioning devices. We also use an air-
powered transfer device, which is made of an almost parachute-like
material. Each of these single-use devices is designed to reduce skin
shear and friction. Each is also completely cleanable, so it remains with
the patient for the duration of their stay.
5. Repositioning patients. When a procedure tips past the 3-hour
mark, we may ask the surgeon to stop so we can perform an intra-
operative skin assessment and make any necessary micro-adjust-
ments to the patient's position. This might not be possible for some
surgeries — robotic cases, for example — but for most it's a chance
to make sure the patient's skin hasn't been compromised and, if it has,
to prevent it from worsening.
A U G U S T 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 8 3
