September 28, 2023
There’s a significant problem in many operating rooms across the United States: Electrosurgical devices can cause significant patient burns and life-threatening fires...
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By: Maria Marinelli
Published: 5/14/2008
Now more than ever, you need to refocus your attention on preventing complications resulting from the improper positioning of patients during surgery. Beginning in October, Medicare won't reimburse for extra care associated with treatment of such preventable injuries as pressure ulcers and nerve injury. Here are four tips to follow.
1. Continually assess the patient
Before positioning a patient for surgery, assess him and identify factors that may interfere with his ability to maintain the prescribed position for the duration of the procedure. Some risk factors that affect a positive outcome include age, height and weight, nutritional status, skin condition and range of motion, respiratory and circulatory status, and immunocompromised patients, such as diabetics or those undergoing steroid, chemotherapy or radiation treatments. Assessment in the OR should be continuous. The circulating nurse is the patient advocate. If there's a change in the patient's position during the procedure, the circulating nurse must re-assess the patient for possible injury from equipment or extremity movement that may cause harm.
2. Measure the patient's risk
The primary nursing diagnosis associated with positioning is to reduce the risk of perioperative injury, such as post-op nerve damage, impaired skin and tissue integrity, impaired circulation and compromised respiratory process. The Braden Scale for Predicting Pressure Sore Risk (www.bradenscale.com/braden.pdf) lets you reliably score a patient's level of risk for developing pressure ulcers. The AORN recommended practices (2008) say you should take additional precautions to decrease the risk of pressure ulcers in patients with Braden Scale scores of less than 20.
3. Anticipate a patient's position
If the surgeon has informed the circulating nurse of a position that differs from those on his preference list, the intuitive nurse will organize and gather positioning devices best suited for that position, such as gel pads, pillows and blanket rolls, before the patient arrives in the operating suite.
4. Document
OR nursing documentation includes pre-op and post-op skin condition, types of positioning devices used, where they were used and the names and titles of all team members involved in the positioning process. In the event of an untoward occurrence, everyone involved in the event should be made aware of the injury. Then the nurse should file an incident or occurrence report.
Ounce of prevention
In a fast-paced ambulatory surgical setting, it's important that you use all possible preventative measures when positioning the patient. Creating cultural change in the OR in order to prevent patient injury should be a goal in all institutions. We must continue to seek out processes that will improve safety in all aspects of patient care. In the OR, we must encourage vigilance in positioning patients for surgery in order to prevent pressure injuries while they are in our care.
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