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 By: Amos Schonrock, MAN, RN, ST, PHN, CSSM, CNAMB, CNOR, NE-BC, Perioperative Patient Safety Specialist

As perioperative professionals, the operating room team has a constant dedication and calling to the creation and maintenance of an environment that keeps our patient free from harm. As a vigilant guardian, the perioperative nurse is often at the forefront of this action. For positioning the perioperative patient, the nurse must use their senses to assess the patient’s well-being and current integumentary status as part of the pressure injury prevention assessment during all phases of care.

Some surgical procedures require extreme positioning to ensure that the targeted surgical area is accessible to the surgeon and the surgical team. Extreme positioning requires extreme positioning devices which are manufactured to meet the need for surgical access first and foremost. Unfortunately, the devices and positions needed for optimal surgical access can increase the risk for an interoperative medical- device related pressure injury. The resultant pressure injury generally mirrors the pattern or shape of the device. One common position that fits the extreme high-risk description is the Lateral Decubitus Position. This position is commonly used during surgery requiring access to the thorax, retroperitoneum, or hip with a patient lying on the nonoperative side and careful positioning of the extremities. The following are some best practices to help when positioning the patient in a lateral position.

One of the biggest responsibilities of the operating room (OR) team is to ensure patient safety. There are many facets to patient safety in the OR. Safe patient positioning is a critical facet since the patient is unable to tell you if they are in pain or uncomfortable.  The first step to improved outcomes related to patient positioning is to look to the evidence for guidance when choosing your positioning device.  There are extrinsic and intrinsic factors that contribute to the development of pressure injuries (PI) in the OR; one of the extrinsic factors is prolonged surface interface pressure. In this week’s blog we will look at a scientific comparison between foam and gel used as positioning devices in order to determine best practice. 

In the last blog we talked about compassion fatigue which is the emotional residue or strain of exposure to working with those suffering from the consequences of traumatic events. It differs slightly from burnout but can co-exist. Compassion Fatigue can occur due to exposure on one case or can be due to a “cumulative” level of trauma. Burnout is a cumulative process, marked by emotional exhaustion and withdrawal associated with increased workload and institutional stress, NOT trauma related.

The lateral surgical position is one of the most labor-intensive surgical positions that depends on brute force and team strength.  The lateral position is not only physically taxing on the staff, but also can be as hard on the patient; therefore, it is important to have an experienced clinical team member leading the way.  The surgeries that rely on the lateral surgical position vary by specialty and include lateral hip, thoracotomy, spine surgery, or kidney surgery. Many times, the lateral position is preferred over prone when possible for obese patients because the bulk of the patients panniculus can be displaced off the abdomen.  To help improve patient outcomes, this blog will discuss the risk and interventions that are involved with placing a patient in the lateral position.