Key Takeaways: Prevention of Pressure Injury Guideline Updates for 2023

New Recommendations to Call for PI Interdisciplinary Team, Risk Assessment & Skin Tone Considerations

The new AORN Guideline for Prevention of Perioperative Pressure Injury provides guidance to perioperative team members caring for patients undergoing operative and other invasive procedures.

New and updated recommendations in this guideline address such topics as PI prevention practices, risk assessment, and skin tone considerations.

Pressure injuries involve localized damage to skin or underlying soft tissue layers as a result of pressure alone or pressure combined with shear; generally, the affected tissue is over a bony prominence, but it may be associated with a medical device.

Patients are at high risk of developing a PI during operative or other invasive procedures because they are immobile throughout most of the perioperative period; they also lack sensation and may be unable to express feelings of pain or discomfort when undergoing procedures.

Surgical positioning is associated with the prevention of PI, and personnel should follow the recommendations for both safe positioning and prevention of PI.

What’s New in the Guideline for Prevention of Pressure Injury

Key Takeaway

• New: Perioperative RNS should participate in the health care organization’s pressure injury prevention program.

Explanation

• A perioperative interdisciplinary team with authority and responsibility to develop policies and procedures and oversee the implementation of a pressure injury prevention program provides a forum for discussion and improvement. 1.1

Key Takeaway

• New: Use a structured risk assessment tool that has been validated or demonstrated as reliable for use  in perioperative patients.

Explanation

• Validated or reliable tools include the Munro Scale, ELPO, PRAMS, and Scott Triggers. These tools assess for different risk factors and duration of OR time, which is likely the most important risk factor. 
• Risk assessment tools do not necessarily include all key factors that may increase the patient’s risk for pressure injury, and they are limited in their ability to determine the importance of one risk factor compared with another or to help determine the cumulative effects of multiple risk factors. Using a risk assessment tool does not replace the need for a comprehensive patient assessment.
• The Braden Scale should not be used for perioperative patients because it does not address risk factors specific to surgical patients.  2.2

Key Takeaway

New: Place high-risk patients on high-specification reactive or alternating air pressure support surfaces.

Explanation

These surfaces are safe and have been demonstrated to be effective at decreasing pressure injury risk in high-risk patients. 3.3

Additional Reading

• Improving Skin Assessment Documentation in the Electronic Health Record to Prevent Perioperative Pressure Injuries
• Back to Basics 2.0: Prevention of Perioperative Pressure Injury

Review the Full AORN Guideline for Prevention of Pressure Injury

• Reviewing and implementing the “Guideline for prevention of perioperative pressure injury” in its entirety should assist perioperative personnel with providing safe patient care.
• Members can log into Guideline Essentials for Key Takeaways, implementation tools, and more.

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