Preventing Pressure Injuries in the Adolescent Patient During the Intraoperative Period

Problem: Pressure injuries can develop at any time in the course of a patient’s hospitalization.  While in the operating room (OR), the patient’s risk is elevated related to the surgical process and the limited ability to properly off load the patient. Prevention interventions must be in places when a patient is most vulnerable. However, challenges arise when what to use and when to use it comes into question. If standardization in product choice is not standardized, it allows each clinician too independently to choose what to use.

Project Object: The goal was to create a positioning and padding standardization in the OR to reduce incidence of pressure injuries during lengthy posterior spinal fusion surgeries while keeping costs low. 

Methods: These cases focused on adolescent idiopathic scoliosis patients that are placed in prone position for an average of 6-8 hours under general anesthesia. Several incidents had arisen in skin tears and pressure injuries on the anterior of the patient and were discovered after the surgery.  Once location of injury was determined several observations in the OR exposed a lack of standardization of positioning devices to include fluidized positioners, blankets, pillows and gels rolls. The first five patients in the study were positioned with fluidized pressure redistribution devices.  The second sets of five patients were positioned with open-cell non-adhesive padding.

Outcome: Both sets of devices proved to be effective with zero pressure injuries in all ten cases.  However, the open cell non-adhesive padding was found to be easier for the clinicians to use effectively and provided overall cost savings for the facility.