Pressure Ulcer Prevention Strategies in Prolonged Surgery

Abstract

Objective: 1) To determine the incidence of pressure ulcers (PU) post-prolonged head and neck surgery. 2) To determine the outcome of interventional strategies on PU development. Method: A prospective study between June 2008 and March 2011.Using the FOCUS-PDCA model, an improvement plan was developed in KFMC for patients undergoing surgery of 4-hour duration. A patient monitoring protocol was developed including a full demographic database, a preoperative risk assessment, an intraoperative prevention method with a skin integrity check list, and a postoperative skin assessment handover. The patients were monitored for signs of PU for the next 7 days. Possible risk factors along with pressure ulcer reduction interventions were evaluated. Results: During the study 230 H&N patients were monitored. The initial incidence of PU was 23.5%. After implementation of the specialty mattress, it decreased to 10%. With the use of additional mattresses, intra- and postoperative PU prevention documentation the incidence deceased to 5%. The PUs that developed were stage I or II; none of them progressed. Duration of surgery was the most important risk factor ( P < .05). The site of PU was in the back in 50% (scapula 29%) of patients. Increased length of stay was associated with PU development ( P < .05). Conclusion: Patients undergoing prolonged H&N surgery are at higher risk of developing PU than patients going for other types of surgeries. Downward trends in PU development were related to the implementation of interventional strategies. The high level of awareness and continuous monitoring prevented further progression of early stage PU.