6. Post-op interventions. A secondary, post-op skin assessment will
determine whether a patient needs any specialized care, such as a
wound-nurse consult or an alternative support surface. Also, just as
we do in pre-op, we'll offload patients from their surgical position —
say, having them lie on their side if the procedure had them placed in
the supine position. We also educate patients on the need to maintain
the offloaded position post-operatively.
7. Monitoring compliance. I recommend auditing 100% of patient
charts to make sure everyone is complying with the prevention bun-
dle. Our first compliance audits of pre- and post-op documentation
screens in our EMRs began in August 2015. After 3 months, once it
became clear that staff had embraced the new protocols, we scaled
back from the 100% mark. We now audit 10 charts per month, and
we're still seeing excellent compliance.
8. Buy-in from all stakeholders. This might be the most impor-
tant ingredient, because if you're not getting buy-in from everyone —
starting with senior leadership, and so on down the line — you're likely
to fail. Pre-op nurses are a fine example. We now bring patients into the
pre-op area earlier to perform the skin assessment, which means more
work for the pre-op nurses. Educating them about what's at stake if we
forgo this crucial step — the potential for patient harm and increased
costs, for starters — has made them understand the extra 15 or 30 min-
utes it adds to the process are a necessity rather than a chore.
Your bundle-prevention team should reflect a diversity of patient-care
stakeholders — nurses, wound-care specialists, surgeons, risk manage-
ment and
C-suite leaders — with passionate champions in each department.
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