Pressure Injury Prevention: AORN Guideline Takeaways for Periop Nurses

An update published in the 2022 Guidelines for Perioperative Practice includes these key recommendations that every team can implement to prevent pressure injuries

Pressure injury prevention is a critical responsibility for perioperative nurses. Patients undergoing surgical procedures are at an increased risk of developing these injuries due to factors such as prolonged immobility, decreased sensation, and the use of positioning devices. The Association of Perioperative Nurses (AORN) emphasizes the importance of implementing comprehensive prevention strategies to minimize the occurrence of pressure injuries, which can lead to significant patient discomfort, increased healthcare costs, and potential complications. By adhering to evidence-based guidelines and best practices, perioperative nurses can play a vital role in safeguarding patient skin integrity and promoting positive postoperative outcomes

Use a structured risk assessment tool that has been validated or demonstrated as reliable for perioperative patients

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

Place all patients on surfaces that reduce the potential for pressure injury by redistributing pressure

All perioperative patients are at risk for pressure injury because they are immobile during the procedure; placed on a relatively hard surface; unable to feel pain caused by pressure, friction, and shear forces; and unable to change position to relieve the pressure.

Before coming to the OR, a patient may have been transported to the emergency department by ambulance and may have waited for many hours on a hard surface. A patient may have undergone a diagnostic procedure that required remaining in one position for a prolonged period. 3.2

Apply prophylactic dressings to bony prominences, such as the heels and sacrum, in high-risk patients

Prophylactic dressings include:

• semipermeable film dressings (i.e., a thin polyurethane membrane coated with a layer of acrylic adhesive),
• hydrocolloid dressings (i.e., a dressing containing a dispersion of gelatin, pectin, and carboxymethylcellulose together with other polymers and adhesives that form a flexible wafer), and
• foam dressings (i.e., open cell, hydrophobic, polyurethane foam sheet). 4.2

Additional Pressure Injury Prevention Resources for Periop Nurses

• Webinar: Preventing Perioperative Pressure Injury-A New Guideline
• Pressure injury Prevention Audit Tool
• Pressure Injury Prevention Case Study

References for Pressure Injury Prevention

2. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline. 3rd ed. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel (NPIAP) and Pan Pacific Pressure Injury Alliance; 2019. [IVA]
3. Ganos D, Siddiqui A.Chapter 7: Operating room. In: Pieper B, ed.Pressure Ulcers: Prevalence, Incidence, and Implications for the Future. 2nd ed. Westford, MA: National Pressure Ulcer Advisory Panel; 2012. [IVA]
4. Kumta N, Coyer F, David M. Perioperative factors and pressure ulcer development in postoperative ICU patients: a retrospective review.J Wound Care. 2018;27(8):475–485. [IIIA] [PubMed: 30086257]