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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. 

The annual Worldwide Pressure Injury Prevention Day is just around the corner on November 18, 2021.  Let’s not forget that perioperative pressure Injury prevention strategies decrease overall hospital acquired pressure injuries (HAPIs) in the non-reimbursable CMS “never event” category.  Awareness around perioperative pressure injuries and the focus on patient risk identification, including environmental and extrinsic risk factors, is gaining traction within the surgical and medical device community. As a result, skin injury prevention bundles, hospital policies, and safety strategies are being researched and recommended throughout the healthcare industry.

Typically, when we think of skin injury prevention in the acute care setting, we think of that immobile, post trauma, geriatric or surgical patient.  There is a plethora of literature and research around the subject yet each year, more than 2.5 million people in the United States develop pressure injuries.  That 2.5 million people represent many different populations from geriatric to neonate. Risk identification and the implementation of pressure injury prevention interventions are well known in the adult population but what about the neonate? When it comes to pressure injuries, we rarely think of the neonatal population.