Sally Sutherland-Fraser
CNC Perioperative Practice Development
St Vincent’s Hospital, Sydney
Reducing Avoidable Pressure I...
Research
• Educational
Intervention
Study
• Perioperative
Nurses’
Knowledge &
Practice with
PI Prevention
in the
Operating...
Research
• Educational
Intervention
Study
• Perioperative
Nurses’
Knowledge &
Practice with
PI Prevention
in the
Operating...
Research
• Educational
Intervention
Study
• Perioperative
Nurses’
Knowledge &
Practice with
PI Prevention
in the
Operating...
BMC 2012 11:25 doi:10.1186/1472-6955-11-25
n=70
PuPP: Pressure Ulcer Prevention Program
Multifaceted educational intervention
Intervention
You’re going to
leave me here
h...
Revised perioperative nursing care records
Purchased new equipment
Moved from a treatment/reporting model
to a preventativ...
Tschannen et al
2012
Scarlatti et al
2011
Schoonhoven et al
2002
Primiano et al
2012
Gunningberg et al
2000
Versluysen
198...
Operating tables and support
surfaces
1840
Wooden table
Operating tables and support
surfaces
Operating tables and support
surfaces
1889
Wooden table
with thin padding
Operating tables and support
surfaces
1890s
Padded tables
Operating tables and support
surfaces
Present day
Visco-elastic foam / bi-elastic cover
McInnes E, Jammali-Blasi A, Bell-S...
Impaired Sensation
Impaired Activity
Impaired Mobility
Pressure
Moisture
Shear
Friction
Regional anaesthesia
Lithotomy position with feet elevated
Reduced mobility & sensation
Shah. 2000
Postoperative pressure ...
Surgical Patient Journey
what goes on behind those doors...?
Chronic Illness
Skin Temperature
Oxygen Delivery
Demographics
Nutrition
Chronic Illness
Skin Temperature
Oxygen Delivery
Demographics
Nutrition
Extrinsic risk factors
Time in the OR
Type of mattress, Position, Positioning devices
Type of surgery
Retractors
Anaesthet...
Preoperative Phase
Anaesthetic and Surgical access
Undo ties and knots in the patient gown
Skin integrity
Preoperative sha...
Impaired Sensation
Impaired Activity
Impaired Mobility
Anaesthesia
Intraoperative Phase
Consider preop assessment score and other data
Communicate with the patient
Manage actual risk factor...
Postoperative Phase
Re-assessment
Communicate with the patient & family
Manage actual risk factors for this pt journey
Rev...
Surgical Patient PI Incidence (SPPII) Study
2014???
References
Armstrong, D. & Bortz, P. (2001). An integrative review of pressure relief in surgical
patients. AORN Journal, ...
Questions
Contact Details
Sally Sutherland-Fraser
CNC Perioperative Practice Development
St Vincent’s Hospital, Sydney
Vic...
Sally Sutherland-Fraser, St Vincent's Hospital - Pressure Injury Prevention During the Surgical Patient Journey
Sally Sutherland-Fraser, St Vincent's Hospital - Pressure Injury Prevention During the Surgical Patient Journey
Sally Sutherland-Fraser, St Vincent's Hospital - Pressure Injury Prevention During the Surgical Patient Journey
Sally Sutherland-Fraser, St Vincent's Hospital - Pressure Injury Prevention During the Surgical Patient Journey
Sally Sutherland-Fraser, St Vincent's Hospital - Pressure Injury Prevention During the Surgical Patient Journey
Sally Sutherland-Fraser, St Vincent's Hospital - Pressure Injury Prevention During the Surgical Patient Journey
Sally Sutherland-Fraser, St Vincent's Hospital - Pressure Injury Prevention During the Surgical Patient Journey
Sally Sutherland-Fraser, St Vincent's Hospital - Pressure Injury Prevention During the Surgical Patient Journey
Sally Sutherland-Fraser, St Vincent's Hospital - Pressure Injury Prevention During the Surgical Patient Journey
Sally Sutherland-Fraser, St Vincent's Hospital - Pressure Injury Prevention During the Surgical Patient Journey
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Sally Sutherland-Fraser, St Vincent's Hospital - Pressure Injury Prevention During the Surgical Patient Journey

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Sally Sutherland-Fraser, Clinical Nurse Consultant, Perioperative Services, St Vincent's Hospital, Sydney, St Vincent's Health Network delivered the presentation at 2013 Reducing Avoidable Pressure Injuries Conference.

The 2013 Reducing Avoidable Pressure Injuries Conference featured a comprehensive case study led program covering topics such as prevention of pressure injuries during the surgical patient journey and in people with Spinal Cord Injuries, meeting Standard 8, translating research into clinical practice and more.

For more information about the event, please visit: http://www.informa.com.au/pressureinjuries13

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Sally Sutherland-Fraser, St Vincent's Hospital - Pressure Injury Prevention During the Surgical Patient Journey

  1. 1. Sally Sutherland-Fraser CNC Perioperative Practice Development St Vincent’s Hospital, Sydney Reducing Avoidable Pressure Injuries Conference Melbourne, September 16-17, 2013
  2. 2. Research • Educational Intervention Study • Perioperative Nurses’ Knowledge & Practice with PI Prevention in the Operating Suite SurgicalPatients’Journey • Preoperative Phase • Intraoperative Phase • Postoperative Phase Opportunities • Education • Documentation • Equipment • Communication Collaboration & Case Management • Incidence Study
  3. 3. Research • Educational Intervention Study • Perioperative Nurses’ Knowledge & Practice with PI Prevention in the Operating Suite SurgicalPatients’Journey • Preoperative Phase Assessment • Intraoperative Phase Reducing Risk • Postoperative Phase Altered Status Opportunities • Education • Documentation • Equipment • Communication Collaboration & Case Management • Incidence Study
  4. 4. Research • Educational Intervention Study • Perioperative Nurses’ Knowledge & Practice with PI Prevention in the Operating Suite SurgicalPatients’Journey • Preoperative Phase Assessment • Intraoperative Phase Reducing Risk • Postoperative Phase Altered Status Opportunities • Education • Documentation • Equipment • Communication Collaboration & Case Management • Incidence Study
  5. 5. BMC 2012 11:25 doi:10.1186/1472-6955-11-25
  6. 6. n=70
  7. 7. PuPP: Pressure Ulcer Prevention Program Multifaceted educational intervention Intervention You’re going to leave me here how long? Please review my post-op PU RA score!
  8. 8. Revised perioperative nursing care records Purchased new equipment Moved from a treatment/reporting model to a preventative model Improved communication & collaboration regarding pre and postop care
  9. 9. Tschannen et al 2012 Scarlatti et al 2011 Schoonhoven et al 2002 Primiano et al 2012 Gunningberg et al 2000 Versluysen 1986 Schultz et al 1999 PI Incidence for surgical patients Papantonio et al 1994 n=100 83% n=208 21.2% n=55 55% n=136 27.2% n=89 21.5% n=258 8% n=>3000 12% n=199 20.6%
  10. 10. Operating tables and support surfaces 1840 Wooden table
  11. 11. Operating tables and support surfaces
  12. 12. Operating tables and support surfaces 1889 Wooden table with thin padding
  13. 13. Operating tables and support surfaces 1890s Padded tables
  14. 14. Operating tables and support surfaces Present day Visco-elastic foam / bi-elastic cover McInnes E, Jammali-Blasi A, Bell-Syer SEM, Dumville JC, Cullum N. Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews 2011 DOI: 10.1002/14651858.CD001735.pub4. 53 RCTs (5 on operating table surfaces) “Pressure-relieving overlays on the operating table and in the postoperative period reduce the incidence of postoperative pressure ulcers, although there is some evidence that certain operating room overlays may result in postoperative skin changes”.
  15. 15. Impaired Sensation Impaired Activity Impaired Mobility Pressure
  16. 16. Moisture Shear Friction
  17. 17. Regional anaesthesia Lithotomy position with feet elevated Reduced mobility & sensation Shah. 2000 Postoperative pressure sores after epidural anaesthesia. BMJ
  18. 18. Surgical Patient Journey what goes on behind those doors...?
  19. 19. Chronic Illness Skin Temperature Oxygen Delivery Demographics Nutrition
  20. 20. Chronic Illness Skin Temperature Oxygen Delivery Demographics Nutrition
  21. 21. Extrinsic risk factors Time in the OR Type of mattress, Position, Positioning devices Type of surgery Retractors Anaesthetic agents Sedation Warming devices Haemodynamics OR staff knowledge Armstrong D, Bortz P. 2001. An integrative review of pressure relief in surgical patients. AORN Journal, 73 (3), 645-674.
  22. 22. Preoperative Phase Anaesthetic and Surgical access Undo ties and knots in the patient gown Skin integrity Preoperative shave, hygiene & continence Temperature management Anticipate potential risk factors for this pt journey ASA score (physical status score from 1 to 5) PI Risk Assessment score Regional or General anaesthesia? Patient mobility, transfer methods, surgical position & positioning devices Duration of surgery & support surface Postoperative instructions regarding position & mobility Plan with the perioperative & postoperative staff Order and install APAM??
  23. 23. Impaired Sensation Impaired Activity Impaired Mobility Anaesthesia
  24. 24. Intraoperative Phase Consider preop assessment score and other data Communicate with the patient Manage actual risk factors for this pt journey Regional anaesthesia Limited mobility, hovermatt for transfers to & from supine position Gel mattress, foam padding & Fracture table 3 hours on table Clean the patient & examine skin (+30 mins) Consider whether 24 hours non-weight bearing or mobilising? Consider postoperative support surface? Plan with the perioperative & postoperative staff Order and install APAM
  25. 25. Postoperative Phase Re-assessment Communicate with the patient & family Manage actual risk factors for this pt journey Review intraoperative documentation Hovermatt for transfers to & from supine position Gel mattress, foam padding & Fracture table 3 hours on table + 1 ½ hrs in Recovery What position in Recovery What support surface in Recovery? Any postoperative assessment score? Communicate / feedback to perioperative staff
  26. 26. Surgical Patient PI Incidence (SPPII) Study 2014???
  27. 27. References Armstrong, D. & Bortz, P. (2001). An integrative review of pressure relief in surgical patients. AORN Journal, 73 (3), 645-674. Australian Commission for Safety and Quality in Health Care (ACSQHC). 2005. Adverse event rates fact sheet. Commonwealth of Australia. Aronovitch SA, Wilber M, Slezak, Matin T, Utter D. 1999. A comparative study of an alternating air mattress for the prevention of pressure ulcers in surgical patients. Ostomy Wound Management, 45 (3), 33-44. Australian Wound Management Association. 2012. Pan Pacific Clinical Practice Guidelines for Prevention and Management of Pressure Injury. Osborne Park WA, Cambridge Publishing. Ayello E. & Lyder, C.H. 2008. A new era of pressure ulcer accountability in acute care. Advances in Skin and Wound Care, 21(3), 134-140 Bennett G, Dealey C, & Posnett J. 2004. The cost of pressure ulcers in the UK, Age and Ageing, 33(3) Beeckman, D., Defloor, T., Schoonhoven, L., Vanderwee, K. (2011) Knowledge and attitudes of nurses on pressure ulcer prevention: A cross-sectional multicenter study in Belgian hospitals, Worldviews on Evidence-Based Nursing, 3, 166-176.Claudia G, Diane M, Daphney SG, & Danièle D. 2010. Prevention and treatment of pressure ulcers in a university hospital centre: a correlational study examining nurses' knowledge and best practice. International Journal of Nursing Practice. 16(2), 183-7 Bliss, M. & Simini B. (1999). When are the seeds of postoperative pressure sown? British Medical Journal, 319, 863-864. Bours, G., De Laat, E., Halfens, R. Lubbers, M. (2001). Prevalence, risk factors and prevention of pressure ulcers in Dutch intensive care units. Results of a cross- sectional survey. Intensive Care Medicine, 27(10), 1599-1605.Clarke, H.F., Bradley, C., Whytock, S., van der Wal, R. & Gundry, S. (2005) Pressure ulcers: implementation of evidence-based nursing practice. Journal of Advanced Nursing, 49(6), 578-590. De Laat, E.H., Schoonhoven, L., Pickkers, P., Verbeek, A.L. & Van Achterberg, T. 2006. Implementation of a new policy results in a decrease of pressure ulcer frequency. International Journal for Quality in Health Care. 18(2),107-112. Gali B, Findlay JY, Plevak DJ. 2003. Skin Injury with the Use of a Water Warming Device. Anesthesiology, 98: pp1509–10. Gerrish, K., Clayton, J., Nolan, P. & Morgan, L. (1999) Promoting evidence-based practice: managing change in the assessment of pressure damage risk. Journal of Nursing Management (7), 355-362. Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay, CR, Vale L, Whitty, P Eccles MP, Matowe L, Shirran L, Wensing M, Dijkstra R, & Donaldson C. 2004, Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technology Assessment, 8(6) Gorecki C, Brown JM, Nelson EA, Briggs M, Schoonhoven L, Dealey C, Defloor T, Nixon J. 2009. Impact of Pressure Ulcers on Quality of Life in Older Patients: A Systematic Review. Journal of the American Geriatrics Society, 57(7), 1175-1183 Gunningberg L & Stotts NA. 2008. Tracking quality over time: what do pressure ulcer data show? International Journal for Quality in Health Care, 20(4), 246-253 Gunningberg, L. (2004) Pressure ulcer prevention: evaluation of an education programme for Swedish nurses. Journal of Wound Care 13(3), 85-89.Gunningberg L & Ehrenberg, A. 2004. Accuracy and quality in the nursing documentation of pressure ulcers, Journal of Wound Ostomy & Continence Nursing, 31(6), 328-335 Gunningberg L, Linholm C, Carlsson M, & Sjoden PO. 2001. Risk, prevention and treatment of pressure ulcers – nursing staff knowledge and documentation, Scandinavian Journal of Caring, 15, 257-263. Halfens R, & Eggink M. 1995. Knowledge, beliefs and use of nursing methods in preventing pressure sores in Dutch hospitals, International Journal of Nursing Studies, 32(1), 16-26 Hayes, P.A., Robinson Wolf, Z. & McHugh, M.K. (1994). Effect of a Teaching Plan on a Nursing Staff’s Knowledge of Pressure Ulcer Risk Assessment and Treatment. Journal of Nursing Staff Development 10 (4) 207-213. Hopkins A, Dealey C, Bale S, Defloor T, & Worboys F. 2006. Patient stories of living with a pressure ulcer, Journal of Advanced Nursing 56(4), 345–353 Kaltenthaler, E., Whitfield, M.D., Walters, S.J., Akehurst, R.L. & Paisley, S. 2001. UK, USA and Canada: how do their pressure ulcer prevalence and incidence data compare? Journal of WoundCare, 10(1), 530-535 McInnes E, Jammali-Blasi A, Bell-Syer SEM, Dumville JC, Cullum N. Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews 2011, Issue 4. Art. No.: CD001735. DOI: 10.1002/14651858.CD001735.pub4. Papantonio, C.T. Wallop, J.M. & Kolodner, K.B. 1994. Sacral ulcers following cardiac surgery: Incidence and risks. Advances in Wound Care, Vol. 7 (2): 24-36. Posnett J, Gottrup F, Lundgren H, & Saal G. 2009. The resource impact of wounds on health- care providers in Europe, Journal of Wound Care, 18(4), 154-161 Prentice JL. 2007. An evaluation of clinical practice guidelines for prediction & prevention of pressure ulcers. Doctoral Thesis. University of Western Australia. Prentice, J.L., Stacey, M.C. & Lewin, G. (2002). An Australian model for conducting pressure ulcer prevalence surveys. Primary Intention 11(2), 87-109. Primiano, M, Friend, M, McClure, C, Nrdi, N, Fix, L, Schafer, M, Savochka, K & McNett, M (2012) AORN, 94(6) 555-566. Reddy, M. Sudeep, S.G,. & Rochon, P.A. 2006. Preventing pressure ulcers: A systematic review. Journal of the American Medical Association, 296(8), 974-984. Scarlatti, KC, Michell, JLM, Gamba, MA & Rivero de Gutierrez, MG (2011) Pressure ulcers in surgery patients: Incidence and associated factors. Rev Esc Enferm 45 (6) 1369-1375. Schoonhoven, L. Defloor, T. & Grypdonck, MHF. (2002). Incidence of pressure ulcers due to surgery. Journal of Clinical Nursing, 11 (4), 479-487. Schultz A, Bien M, Dumond K, Brown K, Myers A. 1999. Etiology and incidence of pressure ulcers in surgical patients. AORN Journal, 70 (3), 434, 437-440, 443-444, 446-449. Scott SM, Mahew PA, Harris EA. 1992. Pressure ulcer development in the operating room: Nursing implications. AORN Journal, 56 (2), 242-245, 247, 249-250. Sewchuk, D., Padula, C. & Osborne, E. (2006) Prevention and early detection of pressure ulcers in patients undergoing cardiac procedures. AORN Journal 84(1), 75-76, 78-80, 82- 88, 90-91, 93-96. Shah JL. 2000. Postoperative pressure sores after epidural anaesthesia, British Medical Journal, (321) pp.491-492. Sinclair, L., Berwiczonek, H., Thurston, N., Butler, S., Bulloch, G., Ellery, C. & Giesbrecht, G. (2004) Evaluation of an Evidence-Based Education Program for Pressure Ulcer Prevention. Journal of Wound Ostomy and Continence Nursing 31(1), 43-50. Spilsbury K, Nelson A, Cullum N, Iglesias C,Nixon J, & Mason S. 2007. Pressure ulcers and their treatment and effects on quality of life: hospital inpatient perspectives. Journal of Advanced Nursing, 57(5), 494-504 Tschannen, D, Bates, O & Talsma, AN & Guo, Y (2012) Patient specific surgical characteristics in the development of pressure ulcers. AJCC 21(2) 116-124. Tweed C & Tweed M. 2008. Intensive care nurses knowledge of pressure ulcers: Development of an assessment tool and effect of an education program. American Journal of Critical Care, 17(4), 338-347 Vermillion, C. (1990). Operating room acquired pressure ulcers. Decubitus, 3 (1), 26-30. Versluysen, M. (1986). How elderly patients with femoral fracture develop pressure sores in hospital. BMJ (292) 1311-1313. Walton-Geer, P. S. Prevention of Pressure Ulcers in the Surgical Patient AORN Journal 89. 538-548. Webster J, Coleman K, Mudge A, Marquart L, Gardner G, Stankiewicz M, Kirby J, Vellacott C, Horton-Breshears M, & McClymont A. 2010. Pressure ulcers: effectiveness of risk assessment tools. A randomised controlled trial (the ULCER trial), BMJ Quality & Safety, published online January 24, 2011 doi:10.1136/bmjqs.2010.043109 Woodbury, M.G. & Houghton, P.E. 2004. Prevalence of pressure ulcers in Canadian healthcare settings, Ostomy & Wound Management, 50(10), 22-38
  28. 28. Questions Contact Details Sally Sutherland-Fraser CNC Perioperative Practice Development St Vincent’s Hospital, Sydney Victoria Street, Darlinghurst, 2010 NSW Australia ahillstreet@gmail.com Mob: 0417480662
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