OPERATING ROOM Pressure on
patient positioning Suitable practices, equipment help
prevent infection, injury by Ebony Smith
atient care requires many measures in the effort to achieve safety and comfort for every patient. One primary concern, no matter the health- care setting, is preventing healthcare- associated infections (HAIs), injuries or other complications that can be harmful, or even worse, fatal for those in care.
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Addressing staff challenges Staff must give special attention to patient positioning in order to prevent pressure injuries or other negative outcomes for patients treated in the operating room, an intensive care unit (ICU), or other hospital or medical facility. Several bar- riers, however, may make the processes of turning or moving patients diffi cult, points out Brittany Hahn, Marketing Communications Specialist, HoverTech International, Allentown, PA. “Challenges facilities face include not having the appropriate safe patient positioning devices readily available when needed, insuffi cient policies and procedures in place, and a lack of ade- quate training and support for staff on patient positioning,” Hahn indicated. “It’s no secret that healthcare workers are extremely busy, and as a result of that, the use of proper equipment and techniques can be overlooked. The best patient posi- tioning equipment in the world has no value unless it’s being used.” Caring for COVID-19-infected patients
presents unique positioning complica- tions, she added.
“Shortly after the virus spread across the US, it was discovered that proning can be used to optimize oxygenation. Although it can be beneficial for patients, the task of proning poses a high risk of injuries to healthcare workers. In order to perform the task safely, it requires proper technique, equipment, and additional staff to keep everyone safe. The burden for this task is especially heavy given the current need to limit the number of staff in ICU rooms to reduce virus exposure.”
Caroline Marchionda, BSN, RN, a clinical specialist at LINET Americas, Inc., Charlotte, NC, states, “One of the biggest problems we as nurses encounter is that the nurse is usually in the isolation room with no other staff. That makes reposi- tioning more stressful for the patient and nurse. We have found the assistance from the Multicare bed helps to turn patients with its frame-based lateral turn technol- ogy. Less staff is needed to care for each patient at a time, which reduces PPE, makes more consistent Q2 hour turns, and makes of oading easier.
Advancing patient safety Obstacles with care-acquired conditions Several national agencies and organiza- tions provide oversight, standards, educa- tion and support regarding patient safety, as it remains a high priority in care. The Agency for Healthcare Research and Quality (AHRQ), part of the U.S. Department of Health and Human Ser- vices (HHS), last March released a report that “reviews 47 practices that target patient safety improvement in hospitals, primary care practices, long-term care facilities and other healthcare settings.” 1 Some main topics in the report include: • “Medication management • Healthcare-associated infections (HAIs) • Nursing-sensitive practices • Procedural events • Diagnostic errors • Crosscutting factors”1 The report went on to highlight the
persistence and impact of hazards with patients, noting, “Despite sustained national attention and notable success- ful interventions in recent years, patient safety remains a signifi cant problem in the United States. Harms such as adverse drug events, HAIs, falls and obstetric adverse events are blamed for thousands of deaths and hundreds of thousands of injuries each year. AHRQ statistics estimate that in 2017, there were 86 hospital-acquired conditions per 1,000 hospital discharges a fi gure that has
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fallen steadily in recent years but remains alarmingly high.”1
Successes with pressure injuries Leading progress in decreasing patient pressure injuries in hospital care is the Joint Commission Center for Trans- forming Healthcare, which last October announced that, “A collaborative project to address hospital-acquired pressure injuries (HAPI) has resulted in more than a 60 percent reduction in a common but pre- ventable issue that claims over 60,000 U.S. lives each year. Led by the Joint Commis- sion Center for Transforming Healthcare, the improvement initiative — including The Johns Hopkins Hospital, Kaiser Per- manente South Sacramento Hospital and Memorial Hermann Southeast Hospital saw these signifi cant reductions sus- tained even as the COVID-19 pandemic accelerated in the United States.”2 Pressure injuries pose a detrimental threat to patient health and life as well as costs of care, growing into an even greater challenge during the COVID-19 pandemic, indicated the commission. “The project launched to identify solutions to prevent and reduce the rate of pressure injuries, also known as decubitus ulcers or bedsores, in health- care facilities after seeing that HAPI were rising nationally. Experts estimate more than 2.5 million patients in U.S. acute-care centers experience pressure ulcers and injuries each year. Because pressure inuries are a signifi cant risk for immobile patients, the country is experiencing a jump in this condi- tion as COVID-19 patients require long hospitalizations.”2
The commission shared that the three hospitals accomplished not only less pressure injuries, but more savings of costs in care.
“Organizations achieved an average 55 percent relative reduction in intensive care unit pressure injuries from May 2018 to December 2019. They continued building on that momentum from January to April
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