Introduction
As a member of the quality improvement committee at Main Urgent Care Hospital, the nursing quality indicator for enhancement in our facility is pressure ulcers in operating rooms. Currently, the prevalence of pressure ulcers among patients, before, during, and after surgical treatments, is high at the current hospital. Gefen (2020) confirms that nearly 1 out of 10 patients is at high risk of developing a pressure ulcer (PU) in the operating room (OR) of primary care facilities.
Therefore, controlling the high risk and prevalence of PU would enhance the quality of care, patient safety, satisfaction, and rating of the Main Urgent Care Hospital. For these reasons, the paper will outline the causes and risk factors of PU, as well as strategies for managing PU risk. The PU risk factors include mobility impairments alongside existing health conditions, impaired patient sensation during surgery, and extreme skin temperature. On the other hand, meeting the desired quality improvement (QI) needs at the hospital includes early assessment of patients’ PU risks, management of skin temperature, and use of surgical technologies in operating rooms.
PU Risks, Causes, and Factors
Lack of mobility or immobility of patients is among the primary causes of PU. According to Gefen (2020), immobility of patients leads to prolonged exposure of soft tissues to deformation, accompanied by severe pain. When external pressure is applied for an extended period, it can cause tissue damage, restricting blood flow to the skin and muscles. This blood occlusion predisposes an individual to pressure-related skin breakdown because it prevents oxygen and nutrients from reaching the tissue, resulting in impaired cell perfusion (Gefen, 2020). Thus, inpatients confined to beds are at high risk of prolonged pressure, leading to the skin, structural protrusion, and PU.
Underlying patient disorders or health issues are also among the risk factors or causes of PU at Main Urgent Care ORs. Heo et al. (2022) indicate that patients with recurring issues such as obesity and diabetes are highly vulnerable to PU in the OR. In addition, Black et al. (2014), as well as Cherry and Moss (2011), also report that blood loss, anemia, low operating hemoglobin, pre-existing skin issues, drug abuse, hypothermia, and hypertension are among the underlying patient issues that may lead to PU in the OR. In this case, underlying diseases may manifest as variations in patient temperature, skin health, and hydration status. This leads to extreme dryness or wetness of the skin, promoting the development of pressure ulcers in patients with longer lengths of stay (LOS) or operating durations (Heo et al., 2022). Therefore, patients with underlying health conditions and longer LOS are at high risk for preventable pressure ulcers at the Main Urgent Care ORs.
Lack of sensation during surgery is another major cause of PU. McKenzie and Ramirez (2018) confirm that sensory nerve injuries and impairments among patients in the OR affect their sensations. McKenzie and Ramirez (2018) explain that the prevalence of pressure ulcers acquired intraoperatively ranges from 12% to 66% in cardiac and spinal treatments that result in sensory nerve injuries, as well as other neurologic operations. In this case, patients fail to perceive or recognize changes in the external environment related to pressure, temperature, shearing, friction, tearing, pain, and skin injuries in operating rooms. This prevents patients from seeking early intervention to avert PU in the OR.
Extreme changes in skin temperature also increase the risks of PU among patients in the operating rooms. Yoshimura et al. (2015) suggest that inadequate management of patient temperature can impact skin health and tolerance to external stimuli. This causes patients’ skin to have extremely high or low temperatures, increasing their vulnerability to skin tears and shearing. This may be risky for patients undergoing surgical treatments that require extreme tilting of the operating table (OT), as Gefen (2020) shows. The tilting increases pressure and friction on the tissues of patients lying on the tilted side of the OT. Thus, when the slanted skin area experiences extremely low or high temperatures, patients may experience tissue tearing.
Recommendations
Early examination of patients’ vulnerability to PU, skin temperature management, and the implementation of surgical technologies within operating rooms are the QI strategies to control the prevalence of pressure ulcers. Based on Gefen (2020), implementing the recommended strategies requires the incorporation of technologies that automatically apply and alternate low pressure in surgical surfaces and OT.
Moreover, implementing the suggested QI plans requires assessing the patient’s risk of developing a pressure ulcer before surgery. This is essential in developing and implementing PU precautions such as pressure redistribution during surgery (Black et al., 2014; Yoshimura et al., 2015). Finally, the IQ plan implementation strategy may entail continuous monitoring and managing the extreme skin temperature of patients in the OR, which would reduce PU risks. In this implementation phase, Yoshimura et al. (2015) suggest the use of temperature management devices to implement this recommendation of controlling PU in the OR.
Conclusion
In summary, lack of patient mobility and underlying health issues are the primary causes of PU. Moreover, extreme skin temperature and a lack of sensation due to impaired sensory nerves in patients increase PU risks at the facility’s OR. On the other hand, solutions for reducing PU risks in the hospital’s OR are available. Finally, assessing patient risks of PU before surgeries would reduce PU prevalence and improve the quality of care at the Main Urgent Care facility.
References
Black, J., Fawcett, D., & Scott, S. (2014). Ten top tips: preventing pressure ulcers in the surgical patient. Wounds Int, 5(4), 14-18.
Cherry, C., & Moss, J. (2011). Best practices for preventing hospital-acquired pressure injuries in surgical patients. ACORN: The Journal of Perioperative Nursing in Australia, 24(2).
Gefen, A. (2020). Minimizing the risk for pressure ulcers in the operating room using a specialized low-profile alternating pressure overlay. Wounds Int, 11(2), 10-16.
Heo, M. H., Kim, J. Y., Park, B. I., Lee, S. I., Kim, K. T., Park, J. S.,… & Kim, J. H. (2022). Prophylactic use of donut-shaped cushion to reduce sacral pressure injuries during open heart surgery. Saudi Journal of Anaesthesia, 16(1), 17. Web.
McKenzie, R. J., & Ramirez, C. (2018). Preventing pressure injuries in the operating room. Am Nurse Today, 13(5), 19-21.
Yoshimura, M., Nakagami, G., Iizaka, S., Yoshida, M., Uehata, Y., Kohno, M.,… & Sanada, H. (2015). Microclimate is an independent risk factor for the development of intraoperatively acquired pressure ulcers in the park‐bench position: a prospective observational study. Wound Repair and Regeneration, 23(6), 939-947. Web.