Activity 8.7: Pressure area protection by Amy Cauldwell https://padlet.com/acauldwell1/aubb6doqbekm How do you monitor and protect the condition of a patients skin and pressure areas in your theatre? What barriers / challenges are faced in order to prevent this happening? en-us 2019-10-14 10:55:05 UTC 2020-01-15 16:03:30 UTC hello@padlet.com When a patient is due to undergo a surgical procedure at my place of work they are asked during their admission onto the ward as to anything which could potentially affect their surgery. This includes the condition of their skin. If any abrasions or bruising etc. are present this is discussed with the surgeon who is to undertake the procedure. Then , if the procedure is to go ahead, the skin areas in question, and its condition, is recorded in the care pathway. When the anaesthetised patient is brought into the operating theatre, any concerns as to their skin condition is passed onto the theatre team. Gel pads are used where necessary along with such things as arm gutters to position the patient comfortably for the duration of their procedure. Gel pads and other padding such as inco pads are also used in such places as arm boards and arm gutters to help alleviate pressure sores etc.The challenges in practice are the tendency for some members of the team, perhaps especially the consultant, to want to get on with the procedure as quickly as possible. This, as I have witnessed, is overcome by the vigilance and thoroughness of the ODP responsible for the care of the patient. https://padlet.com/acauldwell1/aubb6doqbekm/wish/409686577 (Colin O'Connor).]]> 2019-11-11 21:00:04 UTC https://padlet.com/acauldwell1/aubb6doqbekm/wish/409686577 Andrew Abbott https://padlet.com/acauldwell1/aubb6doqbekm/wish/409867251 When the operating department practitioner (ODP) goes and collects the patient from the ward a handover is undertaken. In this handover the registered general nurse (RGN) tells the ODP about any skin integrity and any abrasions or bruising etc. This information is attained at the patients pre-assessment when the out-patient department do the necessary blood test etc. 
In theatre the patients has been anaesthetised and is often helpless, gell pads, gamgee and arms retainers and gutters are used to prevent any sores and make sure the patient is comfy for the duration of the procedure.
Then the WHOs surgical checklist is read out by the ODP the skin integrity and bruising are highlighted to the theatre team.  
 The challenges i faced when carry out these roles as is some team members who have been qualified for sometime and are a bit more relaxed, say that will be fine, also surgeons who are running late rushing to get the list completed. ]]> 2019-11-12 10:46:40 UTC https://padlet.com/acauldwell1/aubb6doqbekm/wish/409867251 Craig Tromans https://padlet.com/acauldwell1/aubb6doqbekm/wish/412034841 Within my place of work the patients are first assessed in pre -assessment. There they will assess how "healthy" the patients are, including the integrity of their skin. When the operation date comes the patients are then admitted onto the ward, where they also will do their checks. By they i mean the staff nurses on shift. When its time the patient will be taken down to theatres, where their care will be handed over to the ODP. Again all sorts of information about the patient will be passed on including skin integrity such as bruising, cuts, rashes and so on. In place to maintain the skins integrity we use gel pads, sponges, inco pads and even blue gauze. All these things will help to cushion the skin and those prone areas to pressure sores. If we did have a patient who developed a pressure sore then we would treat it with cream and document it in the careplan and on riskman. This is so we can find out how it had happened and what we can do next time to prevent it happening again.]]> 2019-11-15 19:57:05 UTC https://padlet.com/acauldwell1/aubb6doqbekm/wish/412034841 8.7 https://padlet.com/acauldwell1/aubb6doqbekm/wish/412579208 Chris Green
All patients will undertake a pre-assessment pre-admission, during the pre-assessment stage patient details will be checked, such as full physical, social assessment and psychological assessment. Full patients’ disclosure of conditions, medical history, comorbidities, allergies and so forth, need to be assessed, so the necessary treatment can be available. Additionally, a specific wound management assessment is also carried out, ‘waterlow’ assessment. Upon being admitted to the ward on day of surgery, the ward staff will again go through the patients pre-assessment notes, checking that nothing has changed. And again, carrying out a physical, social assessment and psychological assessment. The last check point of where the patient is at full capacity would be ward to theatre handover, between an operating department practitioner and registered nurse. The last physical check would be at the patient positioning stage in theatres, where in my experience surgery has been abandoned due to undisclosed skin damage discovered at this late stage. Worth noting that checks and details of any possible skin conditions, bits, abrasions, cuts or markings are full documented at any stage of the patients journey.  

]]> 2019-11-18 09:18:19 UTC https://padlet.com/acauldwell1/aubb6doqbekm/wish/412579208 8.7 - Chris Graham https://padlet.com/acauldwell1/aubb6doqbekm/wish/412636867 All patients undergoing a surgical procedure should be pre-assessed, their skin condition and any relevant co-morbidities should be raised at this point.

This information will stay with them and will inform all members of the MDT involved in their care of how best to deal with their specific condition.

If anything is missed at pre-op, a thorough scrub nurse or ODP will see any potential skin problems (bruises/sores) before the patient's procedure begins and will be able to raise it and mange it if necessary.

In certain operations, patients lie in positions which my increase their risk of developing a pressure sore. This is especially true for long spinal cases as patients are lying prone for a long period of time and unable to move.

Recovery nurses and ODP's assess their skin where they have been lying at the earliest possible opportunity to ensure that pressure sores have not formed and that their skin is not compromised.

Challenges in regards to this are a lax ODP/scrub nurse or poor patient positioning, which can leave them exposed to the potential development of a pressure sore.]]> 2019-11-18 12:23:17 UTC https://padlet.com/acauldwell1/aubb6doqbekm/wish/412636867 8.7 Sharon Bates https://padlet.com/acauldwell1/aubb6doqbekm/wish/412682641 Any patient undergoing a surgical procedure will have a pre-assessment where any information relating to the integrity of the skin will be raised and documented. On admission to the ward, staff will carry out a waterlow assessment and check that there are no potential issues such as a cut/graze on or around the surgical site that may be a concern. There is a safety checklist that is completed by the practitioner that is collecting the patient from the ward to take them to theatre, one of the checks at this point is that, there are no signs of any skin abrasions or existing pressure ulcer and has the patient indicated they have a skin condition?
Once in theatre the team will check on patient positioning for any present conditions if anything is noticed this will be documented.
The position of a patient and the length of surgery during a procedure will increase the risk of a pressure sore developing so ]]> 2019-11-18 13:52:27 UTC https://padlet.com/acauldwell1/aubb6doqbekm/wish/412682641 8.7 Donna Hughes https://padlet.com/acauldwell1/aubb6doqbekm/wish/415638056 The patient will attend pre-assessment and skin condition's should be picked up and reported back to the relevant people, the ward the anaesthetist  , the surgeon ,and theatre co-coordinator.
When the ward are checking in the patient if any issues raised at pre-admission that were missed are communicated to theatre on the day, then we can discuss going forward if anything needs to change in the team huddle regarding the patients needs. Any thing that may have been missed and picked up in the anaesthetic room or theatre is always documented in  the care pathway. The policy states all patients should be on a 80mm mattress, if for any length of time we use the static air mattress, gel pads and pillows if needed to protect pressure areas.  The policy also states to using alternative position on the table for pressure arrears Trendelenburg or 30 degree semi-flower and head up or side tilt when safe to do so. When transferring a patient on and off the table the pressure areas are always checked and documented, any issues should be communicated to the coordinator and on a datix report and full hand over to the ward will be done.

]]> 2019-11-23 11:35:19 UTC https://padlet.com/acauldwell1/aubb6doqbekm/wish/415638056 8.7 Jodie Foster https://padlet.com/acauldwell1/aubb6doqbekm/wish/416246599 A patient is given the opportunity to discuss any skin conditions at the point of pre-assessment, as well as and relevant notes being passed on from the patents GP.  This should also be discussed when being admitted onto the ward as well as a waterlow assessment being completed. 
Any relevant information should be discussed in the pre-list briefing to inform the team. Positioning aids such as gel pads and pillows should be used to prevent the risk of pressure sores developing during the procedure. 
Any pressure sores or skin problems should be documented whether it occurred during the procedure or not. I have had this on many occasions when revealing the area to prep, there may be abrasions ect. on the skin and i always make sure to document before proceeding with prepping and draping.
The challenges I have faced relating this issue is that all ODP's work differently and believe they are correct in their approach, challenging these practitioners can be frustrating as they always believe their way is the correct way. ]]> 2019-11-25 16:30:16 UTC https://padlet.com/acauldwell1/aubb6doqbekm/wish/416246599 8.7 https://padlet.com/acauldwell1/aubb6doqbekm/wish/416605748 Within my organisation the patient is assessed in clinic prior to the operation date . a number of tests will be carried out to ensure they are suitable for the operation one of these tests is a skin strength test, this is known as the Waterlow score. You can also carry out a blanching test, this gives an indication of tissue perfusion quality. The Waterlow score will give an estimated likelihood of a patient developing a pressure sore and also gives us a heads up if they have poor skin quality. Being made aware of a lower skin quality will allow us to adapt certain aspects of the operation such as using elevation technique instead of an exsanguination device when using the tourniquet. We can also use extra padding on the table attachments/ supports to reduce the pressure against a patients skin and also jelly pads for common pressure areas such as ankles and wrists, hopefully avoiding pressure sores. After the operation we can also provide patients with a pressure sore mattress, this is an air filled mattress and is very effective for those with skin integrity issues. 

When any pressure sores are found we will always mention this in a hand over and also have written notes within the patient file stating when and how they occurred and the location of the sore so that the issue can be monitored and any development can be noted.

]]> 2019-11-26 11:34:40 UTC https://padlet.com/acauldwell1/aubb6doqbekm/wish/416605748 8.7 Kerry White https://padlet.com/acauldwell1/aubb6doqbekm/wish/418045706 During the consultation, the patient will have preoperative checks, to enable to clinical team to  use additional equipment necessary to aid pressure relief on pressure point areas.  The patient will under go a tissue viability test and water flow test, this is to ensure the most effective outcome for the patient, whilst maintaining the skin. Other factors will contribute to the patients skin, such as general health, age, allergies, smoking (vaso-constrictor), diabetes and mobility. The Operating Department Practitioner, will assemble the operating table safely, to ensure the correct pressure relief is provided during care. The skin takes less than two hours to start breaking down, so surgical timing will be part of the checks. Furthermore, The patient will be discussed during the team brief, any special instructions to enable patient safety will be added. The ways to prevent pressure sores are, ensuring the correct pressure relieving mattress is on the operating table, gel pads, arm supports, ankle supports, pillows, leg supports. A body map should be mapped in the patients notes before the patient is anaethetised, to make note of any marks on the skin prior to surgery. The patient should receive fluids during surgery, as they have fasted, and will be dehydrated. The team should be reminded that its in the patients best interest, and we are all to support each other, to ensure saftey checks are taken. And it is the law to adhere to policies. 

]]> 2019-11-30 22:21:59 UTC https://padlet.com/acauldwell1/aubb6doqbekm/wish/418045706 8.7 Kay Bolt https://padlet.com/acauldwell1/aubb6doqbekm/wish/420832200 When the patient comes to pre-assessment, they should mention to the registered nurse any cuts, bruises or abrasions that they have on their skin. On entering the anaesthetic room, the nurse hands over the patient to the Operating Department Practitioner (ODP) and informs them of any relevant issues the patient may have e.g. Allergy, skin integrity and posturing problems. Once the patient is on the operating table and depending on the type of surgery, the potential pressure points of their body are supported with memory foam in the operating table mattress, heal and arm gel pads, head ring and pillows. When the patient is uncovered, just before they are prepped, any marks or blemishes that are observed on the patient's skin, that the ward nurse did not mention, are recorded on the patient's care pathway. 
After surgery, when the patient is rolled to remove the slide sheet, their skin is checked for any signs of sores or damage, especially  under the diathermy plate (if used).

]]> 2019-12-06 16:09:36 UTC https://padlet.com/acauldwell1/aubb6doqbekm/wish/420832200 TE https://padlet.com/acauldwell1/aubb6doqbekm/wish/426799166 All our patient which are undergoing surgery have pre-assessment checks where are identify any concerns regarding their health or any other issue there may have.
 
Before a surgery anaesthetist and surgeon will see their patients and ask additional questions and also check their skin.
 
On the huddle we talk about the patient health and anything that can cause patient discomfort during the procedure.
 
All patients should be on 80mm mattress as it state in the policy and use of alternative positioning on the table for protecting the pressure area like static air mattress, gel pads or pillows and also use of Trendelenburg or 30 degree semi-flower, head up or side tilt when is  safe to do so. 
 
Our ODP will go through questions and assess the patient health and their skin document any bruising or scrape that they may have and communicate on the “time out” 
 
On the transfer of the patient from operating table to a bed or trolley, all pressure areas are check and documented.
 
When handing over a patient in the recovery we check the patient wound side and some our recovery nurses like to also check the patient for any pressure sores with the ODP.  
When nurse come from the ward to pick up the patient, they always check the patient wound and pressure area. On the ward they check the patient every two hours depend what surgery they had done.
]]> 2019-12-26 12:04:14 UTC https://padlet.com/acauldwell1/aubb6doqbekm/wish/426799166 8.7 Lisa Loxton https://padlet.com/acauldwell1/aubb6doqbekm/wish/426885290 Patents undergo preop assessment prior to surgery where all details are recorded regarding the patients medical history, co-morbidities, allergies etc. This will help determine any specific interventions needed for surgery and post operatively.

The patient is admitted onto the ward on day of surgery where the nurse looking after them will once again discuss medical history, co-morbidities, allergies and specifically bruising, bites, skin damage.
When the patient is collected from the ward the escort will again ask the patient about skin integrity.


Once in theatre the patient is again asked by the anaesthetic ODP about any breaks in the skin. Before the procedure starts during the surgical safety checklist any skin issues are disclosed to the team.

patients are positioned carefully ensuring any bony prominences are protected through the use of arm retainers, gel heel pads, and other poisitioning aids.

After the procedure when transferring the patient from operating table to bed the team carefully check the patient for signs of skin damage. Should any area be damaged then this is documented in the patients notes and relayed to the nurse upon handover. ]]> 2019-12-27 15:27:43 UTC https://padlet.com/acauldwell1/aubb6doqbekm/wish/426885290 8.7 Charlotte Grayson https://padlet.com/acauldwell1/aubb6doqbekm/wish/431911146 Patients are assessed in pre op clinics and water-low scores are calculated to determine a patients risk of developing pressure related problems on the skin. Patients are then assessed on arrival to Theatre Admissions or the Day Case ward and pressure areas are checked and documented if needed. any info is handed over to theatre staff who apply pressure care such as heel pads and jel pads ]]> 2020-01-15 15:47:35 UTC https://padlet.com/acauldwell1/aubb6doqbekm/wish/431911146