5 Essential Steps to Prevent Pressure Injuries in Surgery

Reducing the risk of perioperative pressure injury (PPI) for surgical patients requires more than tracking injury data and making adjustments. Instead, teams should focus on identifying knowledge and compliance gaps in PPI prevention among all members of the surgical team – and then work to close those gaps. By doing so, every patient can receive consistent, high-quality preventive care, says Ray-an Talatala, DNP, RN, CNOR, NPD-BC, FAORN.

He speaks from experience.

As a perioperative nursing professional development specialist at New York City Health and Hospitals/Bellevue, a Level 1 trauma facility in New York City, NY, Dr. Talatala identified crucial practice gaps in preventing PPIs within his organization. “I could see how we needed a PPI prevention bundle that supported a more enhanced, streamlined, and current PPI workflow," he said. 

In 2024, he spearheaded the creation of a nurse-led, evidence-based PPI prevention bundle. This initiative incorporated six key practices, including:

• Assessing PI risk before surgery using the Scott Triggers Tool
• Applying prophylactic foam dressings and pressure-reducing pads as a standard practice
• Comprehensive documentation of pre- and post-operative skin assessments

Dr. Talatala is proud of the collaborative bundle for many reasons, emphasizing how these combined interventions have strengthened his team’s “collective efforts to prevent PPIs and continue to emphasize the critical role of OR nurses in primary prevention.”

While implementing this bundle was no easy task, Dr. Talatala acknowledges the challenges his team faced along the way. However, these five strategic actions helped his team overcome barriers to create a successful bundle that remains in use today.

1. Secure Nurse Leadership Support for PPI Prevention

   Active involvement from nurse leaders fosters a workplace culture where professional accountability for preventing adverse events is a priority. Their leadership plays a pivotal role in the smooth implementation of a PPI prevention bundle. Also, “securing buy-in from C-suite executives is vital to ensure alignment and engagement from both staff and leadership teams.”

2. Engage OR Staff in All Phases of Bundle Creation and Implementation

   To motivate staff participation, project leaders should emphasize the importance of the PPI prevention bundle and its benefits for patients, the surgical team, and the organization as a whole. Hosting a project kickoff meeting is an effective way to introduce these goals and educate on the clinical, financial, and legal implications of PPI.

3. Collaborate with Other Departments to Help Sustain Bundle Use

   Involve experts from central supply, nursing quality, and the wound care team in the bundle creation process to incorporate diverse perspectives on key aspects of PPI prevention. For example, “our wound care nurses were instrumental in educating on the progression of a PPI and the detrimental effects it can have for a patient.”

4. Plan for Resistance to Aspects of Bundle Adoption

   Resistance during the initial stages of implementation is a normal part of the change process, Dr. Talatala reassures. During the first two weeks of rolling out the PPI prevention bundle, staff compliance was notably low. “Rather than feeling discouraged, I used this as an opportunity to hold one-on-one educational sessions with staff to address confusion regarding the use of the Scott Triggers PI risk tool, which was a significant factor contributing to the low compliance.”

5. Think Through Managing PAR Levels

   A major change in the PPI prevention bundle was applying prophylactic foam dressings for more patients that are identified as high-risk based on the Scott Triggers tool. This shift in practice required an increase in dressing inventory, so “collaborating closely with colleagues in our Central Supply Department helped ensure we had the right number of dressings on hand.”

Learn more about the PPI prevention bundle and get tips and tools to tailor a similar bundle in your own facility by attending Dr. Talatala’s session Bundle Up: Implementing an Evidence-Based Pressure Injury Prevention Bundle in the OR at AORN Global Surgical Conference & Expo in Boston, MA, April 5–8.