89 - Incidence of Surgical Positioning Injuries in a Large Hospital
Implementation: Introduction: The surgical positioning of patients remain a challenge for the operating room care teams. Patients when positioned on the operating table may be immobilized for many hours, being exposed to various risks, and may develop pressure, ligament and muscle injuries, as well as, eye injuries and compartment syndrome. Therefore, in order to establish high quality care standards in this scenario, the evaluation of provided care it is necessary. For this purpose, the application of care indicators can subsidize the evaluation, promoting excellence improvements in patient care. Objective: Describe a new care indicator called Surgical Positioning Injury Incidence Rate (TILPOC) implemented in a university hospital.
Method: This is an experience report of the assessment of the TILPOC on a monthly follow-up basis. The data were recorded after observation of the incidence rate of surgical positioning injuries in the operating room of a large university hospital in southern Brazil from April to August 2019. For that, patients were evaluated daily after the end of the surgical procedure in the operating room and at the post-anesthetic recovery unit by perioperative nurses who were responsible for the observations. The rate of incidence is calculated by the following formula: number of new cases of patients with surgical positioning injuries in the month / total number of patients undergoing surgical anesthetic procedure in the same month X 100, with a maximum desire rate of 1%. Results: From April to August 2019, 5203 surgical procedures were performed, with a total of 21 reports of patients with surgical positioning injury. The avarege monthly positioning injury rate was 0.4% in the analyzed period. Regarding the reported cases, the most prevalent surgical positioning was the lateral decubitus position with 09 (42.8%) patients, dorsal position with 08 (38.0%) patients, lithotomy with 03 (14.2%) patient and ventral position. 01 (4.76%) patient. The reported positioning injuries were: 14 (66.6%) patients with pressure injury, 03 (14.2%) burn patients, 02 (9.5%) compartment syndrome patients, 01 (4.76%) patient with ulnar nerve injury and 01 (4.76%) patient with lower limb pain. Conclusion: The assessment of the TILPOC highlight the necessity of the perioperative nurse attention in order to intensify the patient care. These measures are especially important for patients positioned in lateral decubitus. This is an indicator recently developed in the operating room of the institution under study and presents as a limitation the reports of injuries that are identified only in the operating room or in the post-anesthetic recovery unit and may be expanded to the surgical units where patients are referred. Although the indicator data is still incipient, these data report important evidences regarding the care in the surgical positioning of the patient performed in the operating room, allowing the improvement and safety in patient care.
Co-Authors: Cecilia Glanzner, Rosane da Silva Veiga Pirovano, Fabricio Badalotti