With the federal CMS reimbursements of October 2008, stating that nosocomial infections and development of hospital acquired pressure ulcers were no longer going to be paid for, one of the areas of concern was pressure ulcers in the operating room. Years ago, we never really thought of pressure ulcers originating in my department, we did our cases and primarily observed for post-operative complications such as respiratory failure or bleeding. The patients were on long term bed rest, the bedding was of poor materials and the only thing we as nurses did, was to turn the patients "frequently” and that was to prevent pneumonia. With research, and projects such as IHI’s 5 million lives campaign, SCIP’s studies, Joint Commission, NYS department of Health reporting requirements, pressure ulcers have been brought to the forefront. For the past year and half, I have been having in-services for my staff on prevention of pressure sores and more use of pressure relieving aids for our patients. It was amazing to find a lot of articles and hearing about the cost of and risks of pressure ulcers at our workshops and the Association for Operating Room Conferences. It was staggering to learn that 25% and as high as 66% of post-operative pressure ulcers were operating room induced, and, that they didn’t present themselves for 3-7 days post-operatively-many times the patient may have been discharged. One pressure ulcer can cost an average of $43,180.00. We always perform a pre-operative assessment on skin integrity (among other things). We obtain a baseline assessment to see if there are any pre-existing areas of concern (for example their nutritional status, whether they are on any pressers, and if they are very thin or immunocompromised). We also look at the length of time the procedure will take, and the position of the patient for the procedure. Pressure ulcers can start to occur in as few as 20 minutes and surgeries lasting for over 2 hours. My facility has been very proactive, as we have had a pressure ulcer team for quite a few years and we as educators and staff, have been updated frequently of the prevention and treatment of pressure ulcers.
Tags: Forensic Nursing, Forensic Nursing Chronicles, Forensic Nursing Theories, Forensic Nursing Decubitus Pressure Ulcers Bed Sores
Forensic Nursing Chronicles 
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