Prevention and Management of Pressure Sores in Cardio-thoracic Theatre

Prevention and Management of Pressure Sores in Cardio-thoracic Theatre

Introduction

Pressure sore development in patients undergoing surgery is an important issue in patient care. Department of Health suggested the need to establish targets for pressure sore reduction in 1991. In 1993 it recommended that the presence or absence of pressure sores may now be recognised as an indicator of the quality of care provided by a Trust. The author is currently working as an anaesthetic and scrub nurse at a cardio-thoracic theatre in a London hospital. This hospital is a cardio thoracic speciality hospital. It also does heart and lungs transplantation. The author also got the experience of working in another two London's teaching hospitals.

From her own experiences in different theatre working environments the author noticed that there are variations in the pressure relief methods carried out by preoperative nurses in different hospitals. It was noticed that in many circumstances providing pressure relief to patient undergoing surgery was standard. As a result all the patients may get the same pressure relief without considering patient priorities or surgery duration. Depending on the duration of the surgery the pressure sore management needs to be planned. Pre-assessment should be conducted and an integration of the preoperative unit and theatre should be made. If there is no pre assessment then the special skin care needs of the patient will not be met. The pressure relief methods used for the patient in the ward may not be familiar by the preoperative nurses. So there is a need of educating preoperative nurses.

Patient positioning is another important aspect. Improper positioning increases the risk of pressure related damages to skin, nerves, muscles and joints. The very nature of anaesthesia and surgery increases the risk of pressure sore. These pressure sores visible on surgical patients are frequently not accredited to the time spent in the operation theatre, as the early harm may not become obvious until days or hours later. Damage to the skin could lead to extended hospital stay, increased medical and legal cost.

Most of the sores occurring in surgical patients are preventable and prevention of sores is an important aspect of preoperative nursing care. The emphasis must now be focused on identifying risk factors and implementing appropriate preventive interventions. Therefore, it is very clear that preoperative nurses should be able to prevent and effectively manage pressure sore of patients undergoing surgery. Prevention of pressure sore not only provides a painless life after surgery but also reduces the financial risk of treatment. Vigilance in prevention is also demanded from a financial view point when the estimated cost for treating a serious pressure sore is in the region of £40000.00.

Author discussed these issues with the management, colleagues in the theatre, trust's tissue viability nurse etc. From these observations, discussions and experiences author confirmed that there is a need for improvement in the pressure sore management in her present working environment.

A pressure sore has been defined as an area of necrosis ...