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

ahillstreet@gmail.com

Mob: 0417480662