Reducing Perioperative Injury During Positioning of the Surgical Patient

During the perioperative process, it is of the utmost importance to be aware of, and address, potential complications that the geriatric surgical patient may experience. With advanced-age, the patient develops exceedingly higher risks--patient-specific and procedural-specific--associated with the acquisition of intraoperative injury, such as the formation of pressure ulcers and development of neuropathic injuries. Without the employment of proper technique during the positioning process, and vigilant monitoring during the perioperative process, the patient is a significantly heightened risk for these aforementioned surgical complications. With increased education, employment of effective decision-making, encouraged patient-individualized assessment, and proper intervention (ie. the use of surgical positioning aids), the patient’s quality of care and safety dramatically increases.

In the research process, information was gathered through various databases, primarily ClinicalKey and MEDLINE (PubMed). After the collection process, critical study was completed in order to choose the most fitting articles which best analyzed the [positive] effects perioperative positioning devices provided for patient safety. These scholarly articles were then submitted to critical appraisal using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Research Evidence Appraisal Tool and the JHNEBP Evidence Level and Quality Guide (Dang & Dearholt, 2018).

Subsequently, the studies which were selected were then discussed, compared, and contrasted in their research. All articles exhibited that diligent, individualized assessments of the autonomous patient can ensure the proper employment of necessary interventions (ie. foam pads, RIK mattresses, gel rolls). With this review, many implications of procedural adjustments and decision-making in the surgical setting can be considered. Tactics, such as enhancing and continuing education, as well as requiring semi-annual competency verifications, could be employed to guarantee an individual’s techniques (Spruce & Van Wicklin, 2014). Increasing capabilities in both [1.] proficient communication and [2.] assertiveness of advocacy can better encourage employment of imperative interventions, like assessing, positioning, and monitoring the patient. Understanding the uses for surgical devices, and the differences between them, in their effectiveness of decreasing pressure ulcer formation is essential for high-quality patient care. It is important for the prudent, competent circulating nurse to understand the need for intraoperative positioning aids when positioning the geriatric surgical patient. With increased distribution, or surface area, for the gravitational pressure during long procedures, patient safety is promoted. Conclusively, the vigilant nurse should, as follows: (1.) recognize the individualized needs of the autonomous patient; (2.) make precise pre-assessment judgments; (3.) adjust decision-making and interventions based on patient needs; and, (4.) continually monitor and evaluate effectiveness of interventions (ie. positioning aids).