Sally Sutherland-Fraser
CNC Perioperative Practice Development
St Vincent’s Hospital, Sydney
Reducing Avoidable Pressure Injuries ConferenceMelbourne, September 16-17, 2013
Researc
h
• Educational Intervention Study
• Perioperative Nurses’ Knowledge & Practice with PI Prevention in the Operating Suite
Surg
ical P
atients
’ Journ
ey • Preoperative
Phase
• Intraoperative Phase
• Postoperative Phase
Opport
unitie
s • Education
• Documentation
• Equipment
• Communication Collaboration & Case Management
• Incidence Study
Researc
h
• Educational Intervention Study
• Perioperative Nurses’ Knowledge & Practice with PI Prevention in the Operating Suite
Surg
ical P
atients
’ Journ
ey • Preoperative
Phase Assessment
• Intraoperative Phase Reducing Risk
• Postoperative Phase Altered Status
Opport
unitie
s • Education
• Documentation
• Equipment
• Communication Collaboration & Case Management
• Incidence Study
Researc
h
• Educational Intervention Study
• Perioperative Nurses’ Knowledge & Practice with PI Prevention in the Operating Suite
Surg
ical P
atients
’ Journ
ey • Preoperative
Phase Assessment
• Intraoperative Phase Reducing Risk
• Postoperative Phase Altered Status
Opport
unitie
s • Education
• Documentation
• Equipment
• Communication Collaboration & Case Management
• Incidence Study
BMC 2012 11:25 doi:10.1186/1472-6955-11-25
n=70
PuPP: Pressure Ulcer Prevention Program
Multifaceted educational intervention
Intervention
You’re going to
leave me here
how long?
Please review
my post-op
PU RA score!
Revised perioperative nursing care records
Purchased new equipment
Moved from a treatment/reporting model
to a preventative model
Improved communication &
collaboration regarding pre
and postop care
Tschannen et al
2012
Scarlatti et al
2011
Schoonhoven et al
2002
Primiano et al
2012
Gunningberg et al
2000
Versluysen
1986
Schultz et al
1999
PI Incidence for surgical patients
Papantonio et al
1994
n=100
83%
n=208
21.2%
n=55
55%
n=136
27.2%
n=89
21.5%
n=258
8%
n=>3000
12%
n=199
20.6%
Operating tables and support surfaces
1840
Wooden table
Operating tables and support surfaces
Operating tables and support surfaces
1889
Wooden table
with thin padding
Operating tables and support surfaces
1890s
Padded tables
Operating tables and support surfaces
Present day
Visco-elastic foam / bi-elastic cover
McInnes E, Jammali-Blasi A, Bell-Syer SEM,
Dumville JC, Cullum N. Support surfaces for
pressure ulcer prevention. Cochrane Database of
Systematic Reviews 2011 DOI: 10.1002/14651858.CD001735.pub4.
53 RCTs (5 on operating table surfaces)
“Pressure-relieving overlays on the operating table
and in the postoperative period reduce the
incidence of postoperative pressure ulcers,
although there is some evidence that certain
operating room overlays may result in
postoperative skin changes”.
Impaired Sensation
Impaired Activity
Impaired Mobility
Pressure
Moisture
Shear
Friction
Regional anaesthesia
Lithotomy position with feet elevated
Reduced mobility & sensation
Shah. 2000
Postoperative pressure sores after
epidural anaesthesia. BMJ
Surgical Patient Journey
what goes on behind those doors...?
Chronic Illness
Skin Temperature
Oxygen Delivery
Demographics
Nutrition
Chronic Illness
Skin Temperature
Oxygen Delivery
Demographics
Nutrition
Extrinsic risk factors
� Time in the OR
Type of mattress, Position, Positioning devices
� Type of surgery
� Retractors
� Anaesthetic agents
� Sedation
� Warming devices
� Haemodynamics
� OR staff knowledge
Armstrong D, Bortz P. 2001. An
integrative review of pressure relief in
surgical patients. AORN Journal, 73 (3),
645-674.
Preoperative Phase� Anaesthetic and Surgical access
� Undo ties and knots in the patient gown
� Skin integrity
� Preoperative shave, hygiene & continence
� Temperature management
� Anticipate potential risk factors for this pt journey
� ASA score (physical status score from 1 to 5)
� PI Risk Assessment score
� Regional or General anaesthesia?
� Patient mobility, transfer methods, surgical position & positioning devices
� Duration of surgery & support surface
� Postoperative instructions regarding position & mobility
� Plan with the perioperative & postoperative staff
� Order and install APAM??
Impaired Sensation
Impaired Activity
Impaired Mobility
Anaesthesia
Intraoperative Phase� Consider preop assessment score and other data
� Communicate with the patient
� Manage actual risk factors for this pt journey
� Regional anaesthesia
� Limited mobility, hovermatt for transfers to & from supine position
� Gel mattress, foam padding & Fracture table
� 3 hours on table
� Clean the patient & examine skin (+30 mins)
� Consider whether 24 hours non-weight bearing or mobilising?
� Consider postoperative support surface?
� Plan with the perioperative & postoperative staff
� Order and install APAM
Postoperative Phase� Re-assessment
� Communicate with the patient & family
� Manage actual risk factors for this pt journey
� Review intraoperative documentation
� Hovermatt for transfers to & from supine position
� Gel mattress, foam padding & Fracture table
� 3 hours on table + 1 ½ hrs in Recovery
� What position in Recovery
� What support surface in Recovery?
� Any postoperative assessment score?
� Communicate / feedback to perioperative staff
Surgical Patient PI Incidence (SPPII) Study
2014???
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Questions
Contact Details Sally Sutherland-Fraser
CNC Perioperative Practice Development St Vincent’s Hospital, Sydney
Victoria Street, Darlinghurst, 2010 NSW Australia
Mob: 0417480662