Feeling Rushed? 5 Patient Positioning Checks to Keep Patients Safe

Pressure to rush, limited awareness of positioning injury risks, and gaps in equipment are common reasons these injuries occur. And these injuries, like long-term nerve damage and pressure sores, are more common than you might think, says clinical nurse educator Christina Doby, MSN, RN, CNOR, CNAMB, CSSM, from Inova Fairfax Medical Campus.

The good news is that you have the power to make positioning safer. These five checks can help you keep patients safe and positioning consistent every time.

1. Take a closer look at how time pressure is handled for a case.

   Ask the team how time constraints are felt during case turnover. When you acknowledge pressures like first-case on-time starts, turnover expectations, and OR efficiency metrics, you create space to address how they may lead teams to rush or cut corners during patient care.

2. Re-evaluate skills to assess positioning risk for every patient.

   As a perioperative RN, you need to synthesize the data gathered during the risk assessment to determine what interventions will help decrease the risk of positioning injury. To deliver high-quality care, surgical departments should ensure that staff members receive both initial and continuing education on patient positioning, risk factors, and risk mitigation.

3. Look for what equipment and positioning devices are missing and take steps to get them.

   Financial and staffing constraints can limit the availability of adequate positioning support, equipment, and devices. This can lead to incorrect positioning or the use of defective or improvised items like a rolled towel or IV bag that place the patient at increased risk for injury.

   To purchase and maintain the right positioning equipment, consider the patient population, procedure types, and procedure lengths, as well as patient and staff member safety.

4. For frontline RNs: Make Time To Reassess Positioning

   A final positioning safety check is essential, but it is often missed when things feel rushed.

   Positioning reassessment should, at a minimum, cover:

   • proper padding of bony prominences,
   • head and neck alignment,
   • extremity location, including fingers and toes, and
   • presence of pulses.

   Also assess safety straps for proper placement, tightness, and integrity.

   Remember that patient positioning should remain a continuous focus, since adjustments may be needed throughout the case to correct alignment or relieve pressure.

5. For Leaders: Ensure Positioning Competency

   Leaders can help reduce the pressure to rush by reinforcing a culture where staff never feel the need to compromise patient safety for efficiency.

   They can also ensure surgical teams have proper education and competency verification on safe patient positioning. This education should cover correct positioning techniques, as well as an understanding of patient risks, mitigation strategies, and commonly occurring injuries.

   And staff members shouldn’t use positioning devices without education and subsequent validation. For evidence-based guidance, please refer to the AORN Guideline on Positioning the Patient and Pressure Injury Prevention.

Positioning policies should be an essential part of staff education and clearly outline:

• steps to identify patient risk factors,
• equipment selection criteria,
• positioning steps, and
• documentation requirements.

An ongoing quality review process should be in place to investigate patient positioning safety events, identify improvement opportunities, and support ongoing intervention evaluation.