Download patient positioning and pressure injury prevention in theatre

WOMEN AND NEWBORN HEALTH SERVICE
King Edward Memorial Hospital
CLINICAL GUIDELINES
SECTION F: GUIDELINES RELEVANT TO PERIOPERATIVE SERVICES
PATIENT POSITIONING AND PRESSURE
INJURY PREVENTION
PATIENT POSITIONING AND PRESSURE INJURY PREVENTION
IN THEATRE
PURPOSE
To ensure patient safety with positioning and the prevention of pressure injury during the patient’s stay
in the perioperative department.
PROCEDURE
PRE OPERATIVELY
1. A preoperative skin assessment of every patient shall be performed and documented on the
Theatre Management System (TMS) prior to the commencement of all surgical procedures.
This should include but not be limited to:
• Pre-existing pressure sores
• Overall condition of skin i.e. dry, fragile
• Areas of altered skin integrity
• Areas of moisture
2. During the surgical list briefing and Team Time Out, the following risk factors shall be
discussed by the multidisciplinary team to determine which pressure prevention systems will
be implemented:
• Skin integrity
• Braden scale score (excludes Obstetric patients)
• Pre-existing conditions which may contribute to pressure injuries
• Patient and surgical factors:
 Age
 Weight
 Height
 Nutritional status
 Patient medical and surgical history
 Type of anaesthetic
 Length of surgery
 Position required
3. All members of the multidisciplinary team shall have full knowledge of the pressure injury risks
associated with positions required for surgery and utilise the available equipment to minimise
the risk of injury.
4. Pressure prevention equipment utilised must ensure:
• Reduction in the intensity of pressure
• Bony prominences are protected
• Optimal body temperature is maintained
• Skin remains dry
5. During surgical list briefing and Team Time Out, at least one member from each
multidisciplinary team shall discuss the surgical position required for the procedure and the
equipment required to achieve this position. These positions include but are not limited to:
• Supine
• Lithotomy
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•
•
•
Modified Lithotomy
Trendelenburg
15 degree left tilt (applies to all pregnant women over 20 weeks gestation or earlier if
symptomatic)
6. All members of the multidisciplinary shall have full knowledge of the injury risks associated
with each surgical position. These include but are not limited to:
• Nerve and tissue damage due to compression or hyperextension of joints
• Compromise of circulation
• Compromise of respirations
• Regurgitation
• Accidental disconnection of endotracheal tube
7. All members of the multidisciplinary team shall be involved in the positioning of the patient at
which point appropriate positioning and pressure prevention equipment shall be implemented.
POST OPERATIVELY
1. Post-operatively all patients shall be rolled to remove soiled linen and to thoroughly assess
skin for pressure injury. Any signs of pressure injury or injury related to positioning shall be
thoroughly documented on the Theatre Management System (TMS) and the electronic Clinical
Incident Monitoring System (CIM) and appropriate management commenced.
2. During transfer of a patient to a post-operative bed, measures to prevent friction and shear
shall be implemented.
3. Ensure a thorough handover (as per iSoBAR) regarding pressure management, to staff caring
for patient over length of stay to ensure skin integrity is monitored and maintained.
REFERENCES ( STANDARDS)
Australian College of Operating Room Nurses. (2014-2015). ACORN Standards for Perioperative
Nursing. ACORN: Adelaide, South Australia.
Beckett, A. (2010). Are we doing enough to prevent patient injury caused by positioning for surgery? Journal for
the Association for Perioperative Practice, 20: 1: 26 – 29
th
Phillips, N. (2007). Berry & Kohn’s Operating Room Technique (11 ed.). Mosby Elsevier: Missouri.
Scott, E. (1997). Hospital acquired pressure sores as an indicator of quality: A research programme centred in the
operating theatre. Research Focus: National Association of Theatre Nurses, 20 – 24
National Standards – 1 Clinical Care is Guided by Current Best Practice
8 Preventing and Managing Pressure Injuries
Legislation - Nil
Related Policies - WNHS W130 PREVENTING AND MANAGING PRESSURE INJURY
Related Guidelines - A 2.11 Pressure Injury Prevention
Other related documents – Nil
RESPONSIBILITY
Policy Sponsor
Nursing & Midwifery Director OGCCU
Initial Endorsement
August 2014
Last Reviewed
Last Amended
Review date
August 2017
Do not keep printed versions of guidelines as currency of information cannot be guaranteed.
Access the current version from the WNHS website.
2014
All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual
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2014
All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual
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