4. Assess the skin at admission. If a patient presents with a pressure ulcer already on his heel or her backside, for example, that body area would need additional padding to make sure as little pressure as possible is put on to that body part during the operation. When possible, the heels of a patient should be lifted off the operating table. The simplest way to do that is to use egg crate foam. It comes in a big brick. People tend to break it in half, but you’re better off leaving it as one piece and using it as a cushion under the calf of the patient so that their heels float off the end of it.

Post-surgical heel injuries are very common because if you’re operating on the leg, it’s not moving, so the heel is just dug right into the table. If the patient is draped across the legs, you don’t see the heels. You could dress the heel, especially for patients with significant arthritis or who are having knee surgery, but in most cases foam achieves the same result — getting the heels off the bed — and is a whole lot cheaper.

Repositioning patients is straightforward: Make sure they get off the position they were laying in while in the operating room. If they were on their face all day, they simply lie on their back afterward. If they were on their back all day, however, tell patients they need to give their back a rest and that you need to get them on their side. That usually convinces them to turn, even though it might hurt because we’re moving a body part that just had a surgery.

5. Watch for PACU injuries. I’ve seen a lot of heel injuries take place in post-op knee surgery patients when a physical therapist or another professional tells the patient to bend her knee up, push her heel into the bed and then slide her leg down into the bed. This makes the heel literally run up and down the mattress and leads to blistering. This is a standard exercise and a common occurrence in post-op outpatient settings, so your nurses need to make sure the patients have a dressing on that heel or a sock on their foot to prevent a big friction blister.

Your nurses no longer have to rely on their subjective clinical judgments to assess a patient’s risk of pressure injury thanks to a few emerging detection technologies:

• Subdermal detection systems. Subepidermal moisture (SEM) scanners and heat thermography scanners (pictured) can detect pre-visual pressure injuries by measuring moisture content and high temperatures under the skin. The SEM scanners are about the size of a smartphone, while the heat topographers resemble a mini-megaphone or police radar gun.

There’s also a financial benefit to detecting pressure wounds that existed before patients arrive for surgery: You can prove to insurers that the wounds were present on admission and avoid reimbursement penalties.

• Rotating tables. Continuous lateral rotation tables use compartmentalized hydraulics to move different body parts at different times so patients aren’t in the same position for very long. “Patients can start developing early symptoms of a deep tissue injury during a surgery like a hip replacement that takes a few hours,” says William V. Padula, PhD, MS, assistant professor of pharmaceutical and health economics in the School of Pharmacy at the University of Southern California. “Pressure ulcers can start forming earlier than that in patients who are under a lot of stress and malnourished.”

Dr. Padula, a health economist, cost-justifies the $50,000 beds by noting that the average pressure injury can cost around $100,000 to treat and around $250,000 to litigate.

• Pressure maps. A pressure grid placed under a patient’s body is hooked up to a monitor, so a nurse can explore areas that the patient has been laying on for a long period of time. The sensors in the grid document how the patient is positioned during their recovery. If patients have been stationary for a couple of hours, the map will let the nurse know so she can reposition them.

— Adam Taylor