How is skin assessed prior to OR arrival ?

[mhy12784]

At my hospital we have had recent debate about the process for skin assessment on patients in the periop period. This last month we had 2 AMBULATORY patients come into the OR with undocumented pressure ulcers (which we found in the OR prior to incision).

The debate has been that patients are getting absolutely zero skin assessment done in PST and ASU (only self reporting). OR staff clearly wants something done prior to entering the OR (yes OR nurses do a skin assessment in the OR itself, but having additional sets of eyes on the patients only benefits everybody).

Do patients get a skin assessment in PST or ASU at your hospital ? ASU seemed to be outraged saying that assessing the skin of patients is too embarrassing and inappropriate.

Does anyone have a solid process, or resources on improving something like this ?

[brownbook]

I'm just kind of guessing what PST and ASU mean. I work in ambulatory pre-op. We go by self reporting.

If this happened where I work I am positive it would result in pre-op being held responsible, which I think is appropriate.

But at the same time I can't imagine every ambulatory healthy patient being ok with a head to toe front to back skin assessment, or needing one.

I assume the two cases you uncovered we're in elderly adults who spent most of their time in bed or a chair.

There is, or should be, common sense, fairly easy indicators, a red flag so to speak, for a nurse to do a skin check in the common areas where pressure ulcers appear.

A wheelchair bound patient, a patient from a skilled nursing facility, a patient wearing a diaper, or simply the patient or family answering appropriately whether or not the patient spends the majority of their day in a chair or bed. This is just off the top of my head. These are all cases where pre-op nurses should be held accountable for pressure sore checks.

I'm just curious, have to ask, I've been in OR's for minor procedures. Never with the type of patient I indicated. The patient is on their back on the guerney. Is helped to scoot from the guerney to the OR table staying mostly on their back, and draped for the procedure. I've never seen or heard of the OR team doing a skin assessment outside of the area around the surgical site?

[mhy12784]

One of the patients was elderly and a mess. The other was actually a middle aged adult who had a stage 2 pressure ulcer (he's been less mobile due to a recent back injury).

But yes the OR staff is expected to do a full body skin assessment of every patient, even completely out of the operating area because literally nobody prior to us does anything whatsoever. Zero. PACU does a mediocre job (they always assess the surgical area, but anything else is hit or miss).

This just puts press on the OR staff because if everything isn't documented by us, then the assumption is that it happened in the operating room because everybody else's skin assessment is blank.

That's kind of why I'm trying to find out what other places are doing

[brownbook]

I think it stinks if OR nurses are being held accountable. OR's are on such a strict time clock. It makes no sense for the OR team to add another "delay" in the case start time to do a front to back head to toe skin assessment!

I'm sorry you're being blamed or pressured. It should be caught in pre-op in my humble opinion.

Our pre-op check list has a "skin intact" check off box. But we go by self reporting, and until I read your post I would not have thought about the "red flags" I mentioned.

I am repeating myself but we do have a check off box in pre-op that says "skin intact", the buck should start and stop there!

[RobtheORNurse]

It sounds like some education is in order for the pre-op and post-op staff. Work with your educator to develop a presentation and skills station for skin assessment.

[mhy12784]

It sounds like some education is in order for the pre-op and post-op staff. Work with your educator to develop a presentation and skills station for skin assessment.

Oh we are

Im just trying to figure out do other hospitals do a full (or mostly full) skin assessment for patients prior to OR arrival ?

I mean I know it sounds and must feel awkward for ambulatory patients to get a full body exam prior to entering the operating room, but from a catching everything stance it makes the most sense.