Prophylactic Use of Foam Dressings for Prevention of Intraoperatively Acquired Facial Pressure Injury in Prone-positioning Cases

Abstract Description

Presentation Upload :

Authors (including presenting author) :

Sung KM(1)

Affiliation :

(1)Operating Theatre & Theatre Services Centre, Princess Margaret Hospital

Introduction :

Facial pressure injury not only threats patients physically and emotionally, but also increases healthcare cost. In 1st quarter, 2017, the number of pressure injury patient developed in PMH Operating Theatre (OT) reached a record high of 8 injuries, 7 were facial pressure injuries and all were closely linked to prolonged prone-positioning during surgeries, particularly spine surgeries. The figure was a wake-up call. Considering limitations including less variability of surgery time and impracticability of intraoperative patient turning, the improvement plan focused on applicability of prophylactic use of foam dressings featuring superior fluid absorption and pressure, fiction and shearing forces redistribution.

Objectives :

(1)To reduce the number of intraoperatively acquired facial pressure injury. (2)To test the effectiveness of prophylactic use of foam dressings for prevention of the injury.

Methodology :

Thanks to support from PMH Pressure Injury and Wound Management Subcommittee (PIWMS), a pilot study on prophylactic use of foam dressings for prevention of intraoperatively acquired facial pressure injury was conducted in PMH OT in 2nd quarter, 2017. Target group included all patients who required intraoperative prone-positioning. Prophylactic foam dressings were applied in patients' facial pressure points including forehead, cheeks and chin. Comparison of facial pressure injury figure in 1st and 2nd quarter, 2017 was made to evaluate the outcome. PMH OT Pressure Injury Task Group, encompassing senior OT nurses, was formed to facilitate the study by (1) devising plan and monitoring the progress, (2) educating nurses and encouraging anaesthetists' and surgeons' participation. Facial Skin Assessment and Adhesive Materials Evaluation form was formulated for perioperative facial skin assessment and study outcome evaluation. Preparatory training was provided for OT nurses, aiming at (1) increasing staff’s familiarity with pressure injury prevention and the study, (2) ensuring staff compliance in the study.

Result & Outcome :

The facial pressure injury rate of 1st and 2nd quarter, 2017 were 17.95% (7 injuries per 39 prone cases) and 2.7% (1 injury per37 prone cases) respectively. PMH OT has adopted this practice ever since. The facial pressure injury rate in 3rd and 4th quarter, 2017 were 0% (0 injuries per 62 prone cases) and 0% (0 injuries per 49 prone cases) respectively. Facial pressure injury rate evidently dropped and prophylactic use of foam dressings was proved to be effective for prevention of intraoperatively acquired facial pressure injury.