Staff Nurse, Clinical Nurse III UCSF San Francisco, California, United States
Description: Clinical Problem/Significance The intraoperative environment can make any patient susceptible to Hospital Acquired Pressure Injuries (HAPI). Pressure injuries negatively affect patients not only economically, but physically, and emotionally, as well1. Studies report that pressure injuries occur in 69% of inpatients who have undergone a surgical procedure while hospitalized2. Due to the immobility required for procedures, our patients are unable to reposition themselves when they feel uncomfortable and are often unable to communicate to us. Pressure injuries are typically not apparent at the time that they leave the OR, as they most often become visible up to 72 hours after the incident. Thorough pre- and post-operative skin assessment documentation can assist in evaluating current practices for areas of improvement.
Background [Intra]operative nurses should understand their role in skin protection and the effect they can have on patient outcomes3. Predisposed risks and OR specific risks must be identified. Nurses should perform skin assessment to establish a preoperative baseline against which the compare the patient’s postoperative status3. Prevention strategies include support surfaces, padding, and positioning4. The hand-off process is critical in assisting health care personnel to identify injury in the perioperative setting and implement process improvements to reduce the risks of injury for future patients4.
Clinical Question Can staff education and the utilization of a Skin Assessment Algorithm tool improve skin assessment documentation on intra-operative adult patients to reduce HAPI in procedures greater than 180 minutes?
Evidenced-Based Protocol: Description and Implementation A seven question survey was created to assess staff knowledge and confidence in identifying HAPI. This survey was given pre- and post- educational presentation that was given in-person and virtually. The Skin Assessment Algorithm Tool was developed and distributed throughout the unit and sent by email. The number of documented blanching erythema values were collected in the electronic medical record during four three-week increments.
Results According to survey results, confidence in ability to identify HAPI increased from 50% to 81%. Understanding the importance of documenting areas of blanching erythema increased from 75% to 94%. Documentation of blanching erythema has trended upward post-intervention.
Conclusion Staff education and the Skin Assessment Algorithm Tool proved effective. The data shows a positive impact on nurse confidence in identifying HAPI as well as increased documentation of blanching erythema.
Perioperative Nursing Implications This project will create data to continually assess and improve our preventative measures to reduce HAPI in the operating room based on strong evidence collected through Apex documentation. These measures will evolve as best practices, technology, and procedures change over time.