Evidence-Based Practice Poster Session (Posters #29-#36)
34 - Institutional Guideline for Prevent Injuries by Surgical Positioning
Description: Clinical Problem: This exposure to interface pressure over prolonged periods decreases tissue perfusion and oxygenation of different skin layers. Positioning injury may be temporary or permanent, and the effects of the injury may range from minor inconvenience to long-term functional restrictions, secondary morbidity or even death.
Background: Surgical position must respect the patient's body alignment, without impairing cardiovascular and respiratory functions and without compromising the integrity of the skin and other structures. The occurrence of injuries by positioning is a concern for perioperative nursing; injuries classified as events with damage to patient. Clinical Question: What the best practices for prevent injuries by surgical positioning? Description of Evidenced-Based Protocol: Experience report by hospital in Sao Paulo-Brazil. Initially, nurse manager identified the need for guideline positioning. Afterwards, perioperative nurse proceeds a revision on best practices guidelines by Association of perioperative Registered Nurses-AORN and Brazilian Association of Nurses Operating Room-SOBECC. The resources were available as support surfaces. The position with the support surfaces documented by images with the nursing staff. Institutional guideline constructed using a positioning manual detailing the surgical position, support surface and positioning care. Implementation of Evidence-Based Protocol: Institutional guideline gathered best practices to proceed the surgical positioning and the use of support surfaces available in the institution. Thus, the nursing team, together with the medical team, will be able to apply the recommendations of the guideline to prevent positioning injuries.
Results: Institutional guideline consisting of an introduction to positioning, concept, risk factors, complications, preventive measures, positioning manual, interventions with occurrence of positioning injury, references. Institutional guideline sent for evaluation by nurse manager, anesthesiology team, stomatherapist nurse and risk and quality management. With approval of these areas, institutional guideline made available in the institution's rules and documents system.
Conclusion: Institutional guideline completed and approved by the nurse manager. The institutional guideline contributes to increase the knowledge of this professional through the review of best practices and the association of resources available in the institution for prevention of positioning injuries. Perioperative Nursing Implications: Each team member contributes their knowledge about anatomy and physiology, risk factors and mechanisms favorable to development of lesions, potential complications and devices and accessories for fixation and protection of the patient. Therefore, perioperative nurse should participate in surgical positioning, implement prevention measures individually for each patient and monitor the perioperative skin and neuromuscular integrity of the patient.
