Patient Protection in the Operating Theatre

PART ONE Background Information…

Risk of pressure ulcer and pressure injury formation in the operating theatre Interesting findings that have been reported Pressure ulcers Various contributing factors Areas most at risk during surgery Consequences of developing pressure ulcers Implications for nursing care Conclusion

Some Interesting Findings… Surgical patients account for 20% to 30% of all pressure injuries. Pressure Sores are ‘not only life altering but life threatening’! Usually presents as a burn or bruise with rapid progression within 1 – 3 days post surgery. Pressure injuries are, in most cases, preventable! Patient Positioning: Education is key Claire Williams Tagerwww.surgicalproductsmag.com

Definition ‘ A pressure ulcer is an injury to skin as a result of constant pressure due to impaired mobility’ JAMA, 2006 – Vol 296, No 8. Pressure Ulcers What is a Pressure Ulcer/Sore?

Skin Cell

Stages of Pressure Ulcers Stage 1: Reddening Stage 2: Epidermis Broken Stage 3: Extending into Subcutaneous Tissue Stage 4: Necrosis extends to the muscle

Contributing Factors Extrinsic Factors Prolonged Pressure Shear & Friction Excess Moisture Intrinsic Factors Incontinence Nutrition Immobility Age Diet Medication

Areas Most Susceptible High Risk Head Sacrum Hips Elbows Heels Buttocks Increased Risk Knees Ankles Ears Spine Shoulders

Potential Injuries due to incorrect Positioning Musculosketal An organ system that gives us the ability to move using the muscular and skeletal systems. The musculoskeletal system provides form, support, stability, and movement to the body. )organ systemmuscularskeletal systems Mechanisms of Injury Hyper- extension of joints Stretching muscles / ligaments

Potential Injuries due to incorrect Positioning Respiratory System Main problem – pressure against the chest or diaphragm that interferes with breathing

Potential Injuries due to incorrect Positioning Circulatory System This system may be affected by: Abrupt changes in patient position Pressure on blood vessels

Potential Injuries due to incorrect Positioning Nervous System Main mechanism of injury would be stretching or placing pressure on superficial nerves

Pressure Sores Costs of treatment higher than preventative measures. Cost to patient: Numerous! Pain, discomfort, prolonged hospital stay, altered body image Costs incurred by litigation high. JAMA Vol 296, No 8. Preventing Pressure Ulcers: A Systematic Review

Intervention… The basic treatment of a pressure ulcer or injury is prevention ( Pershall Linda, “Explanation of decubitus ulcers or pressure sores” LDHP Medical Review Services Corporation)

Implications for Nursing Practice Nurses play a vital role in pressurecare Must take part responsibility for positioning Nurse must act as patient advocate Risk assessment tool should be used Be fully informed of equipment available to facilitate adequate pressurecare Document and report any adverse incidents

Any questions???