5 Leader-Driven Strategies for Pressure Injury Prevention

New OR technologies and procedures are increasing length of surgery in many cases. For patients already at high-risk for co-morbidities, this combination is leading to increased pressure injuries such as alopecia and deep tissue sacral injury caused by unrelieved pressure.

“These injuries are occurring even with evidence-based positioning practices and device placement because the mindset toward changes in practice, even simple ones such as adding a one-minute pause during lengthy surgery to reposition, are not being discussed at the leadership level,” according to Cassendra Munro, PhDc, MSN, RN, RNFA, CNOR, magnet, professional practice, and care experience manager at Saint John’s Health Center in Santa Monica, Calif., consultant, and creator of the Munro Pressure Ulcer Risk Assessment Scale for Perioperative Patients©.

With pressure injury on the rise, she says it’s going to take collaboration between leadership, the frontline and industry to tackle pressure injury on several fronts.

“Perioperative nursing leaders are already in the position and have the skill set to be early innovators and early adopters of the latest best practices and technologies available to take a stronger stand in preventing pressure injury,” she stresses.

Strategies to Drive Change

Speaking directly to perioperative nursing leaders, Munro suggests five strategies that can help them make a difference to reduce pressure injury.

1. Foster collaboration: Bedside nurses trying to create a change in culture need support from nurse leaders to coordinate changes in care practices and facilitate the key stakeholders accepting these changes, including physicians and administrative leaders involved in purchasing decisions for positioning devices and equipment.


2. Drive better data management: Information regarding all aspects of pressure injury need to be tracked more efficiently and comprehensively through each phase of a patient’s care, including after they leave the perioperative setting.

   As part of this data management, communication throughput the patient’s care and feedback between providers needs to be standardized so important data on a perioperative patient’s pressure injury can be understood by perioperative team members in efforts such as building a prevention bundle to protect future patients from similar injury.



3. Be a voice for incorporating emerging positioning technologies: Technologies such as thermographic monitoring devices and table surfaces provide new ways to monitor pressure and respond to it before patient injury occurs. Leaders can be the voice for innovation to trial these and other innovative products to help teams understand how such technologies may be beneficial for their patient populations.

   The expense of maintaining the best positioning technologies available must also be discussed and compared as part of a value analysis to understand how capital expenditures balance with costs to the facility when a patient sustains a pressure injury.



4. Start the conversation to abandon tradition-based practices: Why can’t there be intraoperative processes in place to pause and reposition the patient to relieve pressure? This is the kind of question a nurse leader has the power to ask and pursue follow up conversation. So many tradition-based practices exist in perioperative care around positioning that may be leading to patient harm—this needs to change.


5. Focus on preoperative risk assessment: As patient’s age and co-morbidities become a more prominent factor, the preoperative period presents an incredibly important time to conduct a thorough pressure injury risk assessment.

   The results of this risk assessment must also be documented and communicated clearly throughout a patient’s continuum of care for two reasons: the patient’s risk of enduring pressure injury goes down with better awareness leading to action, and any co-morbidities that present inevitable risk for pressure injury can be documented.

“From my vantage point, frontline nurses are eager and willing to drive new practices and support new technologies that take a stronger stand on preventing pressure injury,” Munro adds, “they just need the leadership support to turn a culture shift toward this mindset.”

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Prevention of Perioperative Pressure Injury

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