Partnering for perioperative skin assessment: a time to change a practice culture

Front line staff identified skin tears and stage one pressure ulcers on post-surgical patients undergoing surgical interventions lasting longer than 2 hours. Collaboration between unit-based councils from the operating room, post-anesthesia care unit, and post-surgical units established a new process for early identification and prevention of surgical acquired pressure ulcers (SAPUs). Interdepartmental collaboration was essential to identifying patient safety concerns and developing a new process of pre-evaluation, early identification, and prevention of SAPUs. Specific skin evaluation reports were created to assess the occurrence and prevalence of SAPUs within moments of initial discovery and continuing through the remainder of hospitalization. Patients would have a skin assessment post-operatively performed by the operating room and post-anesthesia care unit nurses together. An internal prevalence study revealed occurrence rates of 7.1% before implementation of interventions. After evaluating 3,035 patients over 2 years and implementation of a new screening process, the prevalence rate was reduced to 3.3%. The resultant decline in SAPUs supports the value of this no-cost change in workflow.