167 - Standardization for Pressure Injury Prevention: Prone Positioning in Comprehensive Cancer Center
Description: Prone positioning in the operating room(OR) is always a hot button issue. Employing the proper pressure injury prevention techniques is imperative to ensure positive patient outcomes.Best practice for interventions have been put in place to help prevent pressure injuries for patients undergoing spinal surgery in the prone position. However, these interventions are not intended for special circumstances such as when patients are requiring longer than planned surgeries. Additionally, the unique patient population at a Comprehensive Cancer Institute brings increased risk due to patients being immunocompromised and having multiple co-morbidities. Patient procedures can rapidly become complicated intraoperatively and may require more OR time than originally planned. There are routinely spine cases that last greater than 8 hours and even as long as 15 hours.Due to the unpredictability of the specific cases at City of Hope, implementing new interventions and standardizing positioning practices, along with gathering data to identify a baseline of staff knowledge regarding proper positioning techniques and pressure ulcer prevention to decrease pressure injury prevalence was a necessity. With this information, knowledge deficits were identified and an educational program providing rationale, evidence based practice, and sharing outcomes was created to assist staff in caring for this patient population. In conjunction with using padded borders on bony prominences, a variety of other products for application on the patient and on the bed were evaluated and reviewed. The operative table is equipped to turn laterally and into the Trendelenburg position, therefore, implementing a time schedule to shift the patient’s weight during a non-critical time in the surgery was also discussed. Utilizing transport devices and a transport team to off-load at pre-determined intervals was also available when table position change alone was not deemed adequate.Standardizing prevention choices based on position during surgery and types of cases reduces pressure injuries in immunocompromised patients undergoing spinal surgery. Staff education is critical to assist staff in making safe choices in the preparation and positioning of these patients. A team including risk management, wound care specialists, and nursing is key to positive patient outcomes. Implications for Perioperative Nursing:Pressure Injuries obtained during surgical procedures in immunocompromised patients lead to poor surgical outcomes. Additionally, pressure injuries have the ability to increase cost and decrease staff morale. Incorporating experts within and outside of the OR while identifying best practices to standardize prevention techniques decreases surgery related pressure injuries. Staff buy-in to the safety measures is also improved when education with return demonstration and competencies are employed.
Co-Authors: Laurice Apellanes, Rachel Garcia, Theresa McCormick, Ida Antonio