Suspected Deep Tissue Injuries and Pressure Ulcers in the Perioperative Area

Wednesday, 1 August 2012: 9:10 AM

Oleg Teleten, RN, BSN, TNCC, WCC
Patient Care Resources, UC Davis Medical Center, Sacramento, CA
Holly Kirkland-Walsh, RN, FNP, MSN
Wound Care NP, University of California at Davis, Sacramento, CA

Learning Objective 1: identify risk factors for the development of suspected Deep Tissue Injuries in the perioperative area.

Learning Objective 2: identify interventions for the prevention of suspected Deep Tissue Injuries in the perioperative patients.

Purpose: Describe the collaboration and education for culture changes in the perioperative areas to decrease the incidence of suspected Deep Tissue Injuries (sDTI) due to prolonged surgical procedures.

Problem: A root cause analysis was performed on all hospital acquired pressure ulcers (HAPU) for 2011. All patients with HAPUs started as sDTI and had a history of prolonged operative procedures which lasted from 10 hours for a single case to 38 hours over 2-3 weeks. All sDTIs progressed to stage III and IV HAPU which were reported to the state.

Setting/Participants: The setting was the perioperative area in a large urban academic hospital providing over 22,000 surgeries per year.  Quality Improvement (QI) wound care and perioperative nurses worked together to develop strategies to decrease the incidence of sDTIs in the perioperative area and to then educate and change the culture.

Description: Each incident was documented with progressive photos and individual patient’s history. A grid was completed to find all shared risk factors along with a literature review to confirm findings. These case studies were shared with the physicians and perioperative QI nurses. All operating tables and surfaces were pressure mapped and interventions were reviewed and tested. An informational powerpoint and product selection were presented at the perioperative nurses monthly meeting.

Results: Through collaboration and education, a better understanding of the etiology, prevention and documentation of  sDTIs/HAPU was acquired by nurses and physicians. Although culture change is slow in a closed environment like the perioperative area, assessments, documentation and interventions are now in use.

Evaluation: The perioperative QI nurses and the wound care team continue to meet monthly to review progress and perform medical record audits and review for quality of care and documentation.