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Homework answers / question archive / Research into practice Assignment: Evidence-Based Practice Guideline Write a fully developed and detailed APA essay addressing each of the following points/questions
Running head: PRESSURE INJURY PREVENTION DRESSINGS 0
Preventing Pressure Injuries in Prolonged Surgical Cases
Stacey L. Willis
N424 – Essentials of Nursing Research
June 1, 2020
In surgical patients (P), does the use of prophylactic pressure injury dressings for prolonged cases (I) reduce the incidence of hospital acquired skin injuries/ulcers (O) when compared to surgical patients without a pressure injury prevention dressing in place (C)?
The review and analysis of resources in this paper are to discern the efficacy of pressure protection dressings in prevention of pressure injuries/ulcers. Surgical patients who have long-lasting cases are at risk for the development of pressure injuries/ulcers. Patients in the operating room are not only immobile, but may be placed one position for several hours depending on the type of surgery they are receiving. Long-lasting surgeries, age of the patient and comorbidities make them more prone to developing pressure injuries/ulcers. Recovering from their surgery should be the only problem patients are faced with once they are out of the post-operative setting. The primary study cited compared incidences of pressure ulcers in post-operative patients who did not receive proper protective dressings in the operating room, to patients who were positioned on a low-profile overlay that provides alternating pressure (AP-overlay) in addition to current facility protocol. Findings indicate the reduction of pressure injuries/ulcers for surgical patients when pressure protective dressings and protective overlay are utilized.
Key Words: Operating room, pressure injury prevention, risk of pressure ulcers for surgical patients, use of pressure preventing dressings
Preventing Pressure Injuries in Prolonged Surgical Cases
There are a number of contributing factors that not only increase the potential for pressure related wound development, but also slow or prevent the healing of them once they occur. Those with chronic health conditions or other contributing factors, typically have lengthier hospital stays and increased expenses for the patient and patient care facilities. For these patients, a long surgical case means that they are immobilized and solely dependent on healthcare workers to position and protect them appropriately. Yet, according to Black, Fawcett, and Scott (2014) up to 45 percent of hospital acquired pressure injuries (HAPI’s) could be attributed to the operating room. A search of evidence-based studies produced several informational documents on pressure injury development in the operative phase of care, as well as a study on what changes can be made in the operating room versus the areas that are invariable. Surgical patients, especially those who undergo procedures lasting greater than four hours, are especially at risk of developing a pressure related injury. Their body has no sensation, their core temperature is lowered; reducing circulation, and in most cases, the patient cannot be moved during the procedure (Gefen, 2020). Implementing a standard protocol for protection from sheering and pressure injuries in the operating room would significantly reduce the overall HAPI’s and lessen the burden of additional expenses.
Focusing on More Than Surgery in Operating Room
The very definition of a pressure ulcer describes the primary factors involved in its development. They develop when tissue damage occurs and may be caused by a multitude of factors such as; ischemia from occlusion, prolonged deformation of the tissues from shearing, or reperfusion injury (Cooper, Jones, & Currie, 2015). Additionally, surgical patients are at risk of developing decubitus ulcers as they undergo mechanical ventilation, immobility, use of vasopressors, and can have prolonged case times (Cooper, Jones, & Currie, 2015). Studies have also shown pressure injuries/ulcers that were caused in the operating room could take as long as 72 hours to appear, which in all likelihood means that pressure injuries acquired in the operating room are being under-reported (Goudas & Bruni, 2019). Not only do these preventable injuries lead to poor patient outcomes, they give rise to increased hospital cost as well; when a surgical patient acquires a pressure ulcer in can add approximately 44 percent to the cost of their surgical stay (Al-Majid, Vuncanon, Carlson, & Rakovski, 2017). The largest physical hardship from the acquisition of a pressure ulcer is obviously carried by the patient. The largest financial burden from a HAPI, is shouldered by the hospital. The Virginia Commonwealth University Medical Center (VCUMC) is one group who has become focused on the solution and prevention of HAPI’s, rather than just the treatment. This approach has literally paid off; VCUMC increased their quarterly pressure ulcer surveys to monthly rounds, they have a Champions of Skin Integrity (CSI) team who work collaboratively with the hospital’s wound team, and after a year of implementing best practice in ulcer prevention, they have a cost savings of $84,000 (Cooper, Jones, & Currie, 2015).
Additional risk factors of pressure ulcers are numerous and wide-ranging. The general health status of a patient must be considered in seeking prevention of pressure ulcers. The patient may present with systemic diseases or be immune compromised. Nutritional status and body mass are also important factors. However; according to Gefen (2020), the utmost risk factors to consider are the things that cannot be changed during the operative phase of care. There are many distinct limitations that apply in the operating room which are not a concern elsewhere in the hospital. The operating table has to be stable, offers little padding for the patient, and has seen scarce change in design over the last century (Gefen, 2020). As if the challenges of the operating room table were not enough, there is the inability to change the position of the patient during surgery. Gefen (2020) writes from the perspective of a bioengineer and highlights a new overlay system that is designed for use in the operating room. Keep in mind that patients in the operating room are exposed to unique group of risk factors such as positioning aides, slowed perfusion, blood loss, and a drop in core temperature (Gefen, 2020). These are all factors contributing to pressure injury/ulcer development and they must be assessed and recognized promptly to adequately decrease the likelihood of pressure wound occurrence.
Summary of Article
A peer-reviewed supporting article is printed in, Wounds International Journal on the website CINAHL. According to the published retrospective study, Gefen (2020) researched the study and found that the “work demonstrated that none of the patients who received the AP-overlay developed perioperative PUs, as opposed to an incidence rate of 6% in the historical controls (i.e. 18 PUs for the 292 patients).” There was a cohort of 100 patients in the study that were compared to with historical control group of 292 patients. The study monitored the blood flow of the sacral skin using a 2-mm, low-profile laser to compare a standard operating room table pad with the AP-overlay. The findings were significant in that there was 40 percent greater overall blood flow to the patient when using the overlay in addition to the typical padding and a staggering 76 percent greater blood flow to the sacral skin when using the AP-overlay with the standard padding (Gefen, 2020).
HAPI’s are devastating to patients and costly as well. Acquiring a pressure injury in the operating room is more common than most realize, it affects one out of every ten patients (Gefen, 2020). The debilitating effects of pressure ulcers demand the implementation of stronger and consistent preventative measures for surgical patients. Many steps are being taken to improve outcomes and reduce pressure injuries for surgical patients and lacing protective dressings over at risk areas is a great start. However; our surgeons and hospital staff must collaboratively work to seek the most up to date research and implement best practice. Surgical patients do not deserve to wake up with increased challenges to heal from, pressure injuries are preventable.
Al-Majid, S., Vuncanon, B., Carlson, N., & Rakovski, C. (2017). The Effect of Offloading Heels on Sacral Pressure. AORN journal, 106(3), 194–200. https://doi.org/10.1016/j.aorn.2017.07.002
Black, J., Fawcett, D., & Scott, S. (2014). Ten top tips: preventing pressure ulcers in the surgical patient. Wounds International, 5(4), 14–18.
Cooper, D., Jones, S., & Currie, L. (2015). In Our Unit. Against All Odds: Preventing Pressure Ulcers in High-Risk Cardiac Surgery Patients. Critical Care Nurse, 35(5), 76–82. https://doi.org/10.4037/ccn2015434
Gefen, A. (2020). Minimising the risk for pressure ulcers in the operating room using a specialised low-profile alternating pressure overlay. Wounds International, 11(2), 10–16.
Goudas, L., & Bruni, S. (2019). Pressure injury risk assessment and prevention strategies in operating room patients -- findings from a study tour of novel practices in American hospitals. Journal of Perioperative Nursing, 1(32), 33–38.
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