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PowerPoint Presentation
PRESSURE INJURY PREVENTION
Management in Operating Theatre
Overview
To evaluate the necessity for evidence-based PI management

Guidelines for organisational-level management
Classification
Risk evaluation and treatment
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Definition
A pressure injury is localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, como
idities and condition of the soft tissue.
- National Pressure Ulcer Advisory Panel (NPUAP)
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Why prevention?
Avoidable, but common
In 2009, recognised as the most prevalent measurable medical e
o
15-25% patients at risk (Australian Commission on safety and quality in healthcare 2010)
Longer hospital stays, increased readmissions and wound care costs
Annual expense of 285 mn A$ (Haeslar and Carville 2015)
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Local policies and procedures
Follow international guidelines 2014 (NPUAP/EPUAP/PPPIA, 2014)
Evidence-based interventions
Organisation-wide implementation (Haesler & Carville 2015)
Risk evaluation using appropriate tool, skin and nutritional assessment
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Prevention with support systems and repositioning
Evaluation and monitoring by staging
Addresss pain through routine checkups and medications
Treatmentt with proper wound care, support systems, medications
Education (NPUAP/EPUAP/PPPIA, 2014)
Procedure followed in healthcare systems
Stages
Stage 1: Non-blanchable erythema
‘at risk’
Intact, localised non-blanchable skin
No visible blanching in dark skin tone
Painful, firmness & temperature changes
(Wounds Australia 2012), (Nursing2017 2017)
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Stage 2: Partial thickness dermis loss
Open wound, moist and pink-red
Intact
uptured serum-filled bliste
No slough
uising
(Wounds Australia 2012), (Nursing2017 2017)
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Stage 3: Full thickness dermis loss
Full skin loss with exposed subcutaneous fat
Bone, tendon or muscle not visible
Slough, eschar present
Depth of tissue damage depend on position
Undermining & tunelling
(Wounds Australia 2012), (Nursing2017 2017)
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Stage 4: Full thickness tissue loss
Bone, muscle or tendon exposed
Slough/ eschar visible
Palpable fascia, tendon, ligament
Osteomyelitis
(Wounds Australia 2012), (Nursing2017 2017)
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Unsteagable PI
Full thickness tissue loss
Depth unknown
Slough/eschar covered base
Stable eschar not to be removed
(Wounds Australia 2012), (Nursing2017 2017)
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Suspected deep tissue injury
Discoloured region
Covered by intact skin/ blood-filled blisters
Subcutaneous tissue damage from pressure
Worsen even with optimal treatment
(Wounds Australia 2012), (Nursing2017 2017)
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Risk Management
Waterlow score
Consists of 9 sections
BMI
Age/sex
Skin type
Mobility
Continence
Nutritional status
Tissue integrity
Neurological problems
Surgery/trauma
Each section, specific score range(Wounds Australia, 2012)
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Significance of Waterlow score
Specific indicator for surgery
Increased risk in surgical patients (12-66%) (Sutherland-Fraser, McInnes, Maher and Middleton 2012)
Type, length and position
Recovery time
Existing risks
Medications (Bateman 2012)
Use of non-scientific preventive methods (Scott , Mannion, Davies and Marshall 2003)
Effectively used across healthcare settings (Waterlow 2007), (Thorn, Smith, Aziz, and Holme 2013)
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Procedure
Risk assessment by trained nurse on admission
Yes/no answe
Review on every second day
Stage any existing ulce
Sum up the values
At risk, high risk and very high risk categories (Webstar 2010), (Baxter 2005)
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Waterlow Risk Levels (Waterlow 2007)
    SCORE    RISK LEVEL
    10+    At risk
    15+    High risk
    20+    Very high risk
Treatment
Positioning – supportive and pressure redistributing (Bateman 2012)
Skin quality check
Maintaing nutritional status
Avoid hypothermia (Shoemake and Stoessel 2007)
Moisture balance (NPUAP/EPUAP/PPPIA, 2014)
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Future Challenges
Even fatal, but preventable
Only 60% receive proper evaluation
Few evidence-based resources
Integrating multiple risks into a standard reduce individualised focus
Organisation-wide leadership, policies and education required (Buck 2018)
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References
Australian Commission on safety and quality in healthcare (2010) Preventing and Managing Pressure Injuries Standard 8: Factsheet, Available at: https:
www.safetyandquality.gov.au/ (accessed at 31 August 2018)
Bateman S. (2012) Preventing pressure ulceration in surgical patients. Wounds UK, vol 8 (4), pp. 65-73. Available at:www.hrhealthcare.co.uk (accessed at 2 September 2018)
Baxter S. (2005). An examination of how nurses use the Waterlow scale for judgement and decision making in continuing care. University of Stirling. Available at: https:
dspace.stir.ac.uk
(accessed at 2...