Track: Clinical Improvement/Innovation
Clinical Improvement/Innovation Poster Session (Posters #354-#363)
Description: Abstract Study Question: Will determining the risk for pressure injury preoperatively, creating a process for intraoperative skin assessment and utilizing a positioning aid bundle in the plan of care for high risk patients affect the incidence of hospital acquired pressure injury (HAPI) attributed to the intraoperative phase?
Background: Pressure injuries in the US cost approximately $26.8 billion annually. Patients undergoing surgical procedures are at increased risk for pressure injury due to a variety of factors including comorbidities, nutritional status, age, American Society of Anesthesiologists (ASA) Score, Body Mass Index (BMI), surgical position, positioning aids, and length of surgery. Design
Description: Based on a literature review, opportunities for improvement were identified. The key areas of focus were preoperative risk assessment, intraoperative pre-procedure and post-procedure skin assessment, accurate documentation, use of approved positioning aids to evenly disperse pressure, and a bundled plan of care for specific positions. The Scott Triggers Preoperative Risk Assessment Tool was implemented into the Electronic Medical Record (EMR), a Safe Skin Scan Assessment was implemented preoperatively and postoperatively, foam-type positioners were replaced with gel products and foam protective dressings were utilized on bony prominences. Methodology: Reviewed literature; Communicated plan to all stakeholders: surgeons, anesthesiologists, and operating room (OR) and intensive care unit (ICU) nurses; Scheduled positioning fair to view products and evaluate gel product of choice; Partnered with purchasing department to obtain the best pricing with the chosen vendor; Selected an appropriate and validated Preoperative Pressure Injury Risk Assessment Tool: Scott Triggers; Provided staff education related to skin assessment techniques and reviewed common descriptive terms for documentation; Began conversion to gel positioning aids vs eggcrate-type foam; Partnered with Susan Scott for permission to place the Scott Triggers Pressure Injury Risk Assessment Tool into the EMR providing a mechanism to obtain results based on validated criteria and determine high risk patients; Utilized information from the literature and AORN tool kit to create positioning bundles for high risk patients; Created a Safe Skin Assessment technique to be utilized preoperatively and postoperatively to address alterations in skin integrity; Educated the perioperative team members on the Safe Skin Scan technique and the appropriate EMR documentation; Completed and reviewed quarterly updates regarding the expectations, challenges and understanding; Communication during huddles, handoffs and to all stakeholders throughout the process. Metrics of Improvement: Compliance for documentation of preoperative and postoperative safe skin scan; Utilization of the appropriate positioning bundles for high risk patients; Surgical and Neuro ICU HAPI's associated with the intraoperative phase six months pre-interventions to current.
Co-Authors: Theresa Emerson, Mary-Louise Hooper Shulman, June Fernandez, Cyril Bangud, Scherry Quion
The Johns Hopkins Hospital