Electronic Signature First Aid Risk Assessment Made Easy

E signature first aid risk assessment

okay our webinar topic today is performing and communicating a thorough risk assessment for pressure injury prevention our presenter cassandra monroe is a professional consultant nurse scientist researcher and creator of the monroe scale you can see on this slide the presenter's disclosures after today's presentation you should be able to identify contributors to hospital-acquired perioperative pressure injuries describe the application of the monroe scale for perioperative pressure injury risk assessment and discuss the importance of communication of perioperative pressure injury level of risk now i'd like to turn the program over to cassandra to begin elise thank you so much and thank you for the audience taking the time to listen and learn about pressure injury prevention through risk assessment this is our agenda and the literature frequently indicates the need for perioperative specific risk assessment and has identified risk assessment as one of the first steps of action to prevent pressure injuries so let's take a look at the pressure injury problem pressure injury development happens when bony prominences under the layers of tissue create constant pressure for sustained duration this causes tissue ischemia loss of circulation and therefore decreased nutrients and oxygenation to those tissue layers eventually tissue necrosis occurs due to the intensity and unrelieved pressure injuries can also be developed by medical devices the joint commission drew attention to this long-term problem of hospital-acquired pressure injuries by making prevention of them a national patient safety goal from 2006 and it remained a goal until 2018 it's because approximately 60 000 patients die annually related to complications from pressure injuries data gathered for the update of hospital acquired conditions by the agency for health care research and quality reports a six percent increase in pressure injuries when the 2014 data was compared to the 2017 data prevention could lead to an estimated cost savings of over 10 billion dollars so to ensure you know what i mean when i say perioperative i'll define it this is inclusive of the three phases of care of a patient undergoing surgery or procedure i'm speaking of the time period of admission to the preoperative unit the intraoperative phase and the immediate postoperative phase of recovery from anesthesia for an inpatient who needs surgery the preoperative phase could be the immediate pre-surgery preparation period the intraoperative phase is the time period inside of the operating room and the post-operative period includes both phase 1 and phase 2 recovery the pressure injury problem in the perioperative setting is multifaceted these risk factors are not being identified in the widely used inpatient scales such as the brain scales were not specifically designed for this perioperative setting and some of the efforts to create scales for this population were not comprehensive they were missing risk factors risk scales do not include a frequency interval and only patients on the inpatient unit receive additional assessments using the same scale without the use of a scale there is no standardized documentation for the evaluation of pressure injury risk and if it's not being performed or documented then it certainly is not being communicated these problems are all addressed when you use the monroe scale it identifies risk factors for pressure ulcer devel development it's specific for perioperative patients it's comprehensive in its assessment because it has the majority of the risk factors it also increases the frequency of risk assessments there are three phases being assessed this is a documentation tool for pressure injury risk assessment and it's a communication tool for pressure injury risk assessment to the next phase of care especially and including the inpatient population i want to expand upon the frequency and the concept of defined intervals so standards were established for prevention of pressure injury including additional assessments upon a changing condition so in the perioperative setting the defined intervals are the three phases of care pre-operative assessments are not sufficient because change in condition occurs when the patient is exposed to the intraoperative and then the postoperative risk factors so in north america over 30 000 major surgeries per 100 000 population are performed each year all of these patients are considered at some level of risk for developing a pressure injury pressure injuries are preventable and considered never events so let's take a few minutes to review these risk factors using the mnemonic c monroe scale the c monroe scale mnemonic or acronym was created for the education of nurses and aid recall of the perioperative risk factors so what you see on this slide is not the monroe risk assessment scale i'll show you that next and teach you how to use the monroe scale to perform a risk assessment this image shows the lanyard that you can make from a template that will be available in the toolkit familiarizing yourself with the risk factors will facilitate using the monroe scale risk assessment there are six risk factor categories in the first preoperative subscale the c of the semen row accounts for comorbidity risk factors and current health status the patient's comorbidities are indicators of compromise of skin integrity insufficiency of defense mechanism failure of function of bodily organs to resist tissue breakdown and disease processes that affect tissue perfusion and tissue tolerance leading to potential risk of pressure injury behaviors and lifestyle interact with the health condition of the patient and their response to anesthesia and surgery comorbidities and current status vary for each patient and the nurse must understand the prominence of each health issue the disease status may change from the same patient from one procedure to another procedure when they're exposed to multiple surgeries at different times smoking respiratory diseases hypertension hypotension cardiovascular diseases and diabetes are risk factors indicated in the literature to contribute to pressure injury the prior history of or the existence of a pressure injury at the time of surgery would increase the possibility of a new injury to develop the remaining preoperative risk factors are listed and represented in the word monroe m is the letter that represents evaluation of the patient's mobility status u poses the question of the patient's age and if it's under 60. n is for the evaluation of the nutritional condition of the patient r represents the question related to the right weight for the patient and to recognize if there was a recent weight loss o represents the inquiry of the bmi to determine if the patient is overweight the second word symbolizes each of the intraoperative and some of the postoperative risk factors the first four letters of the second word scale the scal reflects the intraoperative risk assessment these letters are where we do the evaluation of the seven risk factor categories from the monroe scale so starting with s that's the appraisal of systolic blood pressure baseline and fluctuation throughout surgery and it also is the surface the patient has been placed for the surgical experience sieber presents core body temperature signaling the impact of hypothermia and pressure injury risk a refers to anesthesia type and the american society of anesthesiologists physical classification that's the asa l is paired with the lying position of the patient during the surgery and the presence of moisture that the patient may be laying on as a result of causes such as irrigation used throughout surgery the post-operative risk assessment has two risk factors these categories are shown with the last two letters of the word scale lnd l represents the total length of stay for the patient in the entire perioperative arena e is the indicator for estimated blood loss from both the intraoperative period combined with any sanguinous fluid accounted for in the post anesthesia care unit so risk assessment is an intervention for prevention the pressure injury risk factors spanning the preoperative intraoperative and post-operative phases of care within the monroe scale are three separate sub-scales for performing an individualized risk assessment and this should be documented in the electronic health record the monroe scale is a standardized and collective risk assessment collective because it's an accumulation of all three subscales there is no equal to this comprehensive instrument this slide is the first sub-scale in the monroe scale pre-op initiates the evaluation of the risk factors for pressure injury please note that for demonstration purposes only the total column has been populated with a sample risk assessment so you can see the cumulative calculation of risk let me describe the scale to you as a structure with columns and roles on the left starting column you will see the list of risk factors you see the word mobility and then as you go through the row to the right you have a one two and three and underneath each of those values is the description of that risk factor so as you're assessing a patient you start with the first risk factor on the left and you select which is the appropriate value based on the description and you enter that amount in the total column nutritional status is the second evaluation and again for this demonstration i have entered a value of one making the total of the preoperative monroe scale a six here you see at the bottom of the subscale is a dichotomous section with comorbidities this is either a one value for the presence of the risk factor or no value if this risk factor is not one of the comorbidities your patient has when you have a total you should also keep in mind that you are performing the risk assessment and that needs to be documented so the signature space has been provided with the date and time but it's also crucial to communicate so there is a section for who did you communicate this level of risk to in the next phase of care in a similar fashion the structure of the intraoperative subscale has a left hand column listing the risk factors physical status anesthesia the body temperature hypotension moisture surface and position are all on the left again in the same fashion there are three levels of risk potential equating to a total number so in the first afa score the patient received a 3 for a moderate to severe systemic disease evaluation by anesthesia as you total this intra-operative risk assessment you will see a space to enter that amount because the risk factors are compounded and cumulative we will also add the preoperative risk factor total making a new intraoperative monroe score total a new level of risk this again is an assessment performed by you and then communicated by you to whom can be indicated on the risk scale so here is the postoperative phase when performing a risk assessment we should not use an estimated or scheduled time of surgery but the actual time of surgery plus the pre-operative and post-operative time because the duration of pressure is what causes the decrease in the blood flow to tissue and eventual necrosis the structure of this post-operative subscale is the same as the other two on your left hand column are the risk factors and the three levels of risk are the rows with their description below it enter the post-operative evaluation scores in the total column and then when you have your post-operative sub-score subtotal that will be added to the intra-operative monroe score total for a cumulative total which is the finalized monroe scale risk level so the literature is very clear about the first steps to prevention of pressure injury it's to assess and identify those who are at risk evaluation and risk assessment of the patient as well as placement of preventative measures is ongoing to provide continuity of care into the inpatient units inpatient nurses are mostly unaware of what happens behind the red line because some pressure injuries do not surface for 24 to 72 hours after the procedure these risk factors associated and created by the surgical experience and proper preventative measures were being missed as these patients were not being considered as high risk on the inpatient unit for quite some time i've been saying prevention does not stop once surgery is completed understanding the importance of continuity of care beyond the surgical period is imperative as it is necessary and appropriate to continue preventative measures perioperative nurses should perform a comprehensive risk assessment for all patients to identify risk factors using three defined intervals the preoperative intraoperative and postoperative phases and remember that prevention doesn't stop when the procedure ends so be sure to communicate the risk assessment for pressure injury into the inpatient unit there are resources now available to you in the toolkit and these are the references i used for this course thank you so much for your time thank you cassandra for sharing your knowledge and expertise on this important topic i'd like to remind our listeners for you to receive contact hours for this presentation you must complete the learner evaluation complete the evaluation by using the link in your purchase confirmation email or by visiting the aorn website once you have submitted your evaluation you can print your certificate thank you all for joining us today this concludes our nursing continuing professional development activity