Preventing pressure ulcers should be a priority for hospitals. Not only do they often cause harm to patients, but treatment isn’t always covered by payors since they’re seen as “never events.” While some may think prevention falls only to nurses, your surgical team may also play a significant role in keeping pressure sores under control.
An article from Patient Safety & Quality Healthcare (PSQH) lays out why surgery makes patients more vulnerable to pressure ulcers.
Risks & warning signs
During the period of immobility patients experience during surgery, the body starts reacting as if a patient were on bed rest. Blood vessels enlarge, which results in fluid loss and blister formation. Patients are also immobile immediately afterward in recovery, and that makes the symptoms worse.
Between preparing for surgery, waiting to go into the operating room and recovery, a two-hour surgery could add up to over six hours of immobility for a patient.
Surgical staff often aren’t thinking of how they can keep patients from developing pressure ulcers, mainly due to the fact that patients don’t develop ulcers until hours or days after they’ve been immobile.
But research shows that patients’ pressure injuries can be attributed to a recent surgery anywhere from 5% to over 53% of the time.
That means surgeons must do more, starting with identifying patients undergoing surgery who may be at a higher risk of developing a pressure ulcer after the procedure’s complete.
Risk factors include being older than 60, being diabetic, having a body mass index (BMI) lower than 19 or higher than 40, having albumin levels lower than 3.5 g/dL, having pulmonary disease or hypotension, or having a low core temperature.
Surgeons should also keep a close eye on patients who are scheduled for surgeries lasting three hours or more, those who’ve experienced trauma and those who are in prone positions. In addition, certain types of surgery are more likely than others to lead to pressure ulcers, including cardiac, vascular, bariatric, transplant or orthopedic procedures.
Detecting, preventing issues
To identify risk factors before surgery, the PSQH article suggests that surgical staff use assessment tools designed to help providers determine whether a patient is more likely to have problems that contribute to the development of a pressure ulcer.
Example: The Scott Triggers Tool can be used to identify patients based on four key risk factors:
- BMI or albumin levels
- American Society of Anesthesiologists (ASA) score of 3 or higher, and
- estimated length of surgery.
If patients are at risk, there are several preventive measures that can be taken to reduce the chance a pressure ulcer will develop. Specifically, surgical staff should use an OR skin bundle protocol, which is a series of standardized, evidence-based interventions designed to stop pressure ulcers from occurring.
A major part of most OR skin bundles is an assessment of the patient’s skin by surgical staff. The condition of the skin should be monitored and documented both before and immediately after surgery, so any problems can be corrected before they turn into pressure ulcers.
Staff should also practice safe patient handling techniques, including carefully shifting the patient’s body to avoid having too much pressure placed on key areas during surgery (such as the heels). Various positioning devices can also be used to alleviate pressure, as well as the use of different pads on the operating table (high-specification foam mattresses instead of the standard elastic foam and fabric pads).
It’s also helpful to encourage patients to move as much as possible before preparations begin, and to start moving again as soon as they can after surgery.
If a skin problem does start developing during or immediately after surgery, the use of protective dressings can keep a small wound from turning into a pressure ulcer. Additionally, thorough handoff conversations between surgeons and other clinical staff can help doctors and nurses in the recovery area better handle potential problems post-surgery.
Surgical staff should be aware of the importance of pressure ulcer prevention, and OR care protocols should include techniques designed to keep these sores from harming patients. Even if patients aren’t at high risk, certain practices, such as reducing stress on the body’s pressure points and improving handoff conversations, can boost overall outcomes post-surgery.