The Association of periOperative Registered Nurses (AORN) has released a revised perioperative pressure injury toolkit, which was built on international guidance from 2019.1

Ellice Mellinger, MS, BSN, RN, CNOR, senior perioperative education specialist for AORN, and Lisa Spruce, DNP, RN, ACNP, CNOR, CNS-CP, ACNS, FAAN, director of evidence-based perioperative practice for AORN explained to Same-Day Surgery (SDS) more details about this toolkit.

(Editor’s Note: Mellinger and Spruce provided their answers in writing. This transcript has been lightly edited for length and clarity.)

SDS: What are some of the changes in this edition of the toolkit?

Mellinger: There are perioperative-specific screening tools to assess the level of risk of perioperative pressure injury. Instructions for use are available in the toolkit. Evidence-based, revised educational slide decks are available. A manager or educator can teach their team by accessing the four slide decks from the AORN website.

In addition to great content and images, there are also “speaker notes” to help the instructor. Content includes basic patient positioning in surgery, pressure points, strategies to prevent perioperative pressure injuries, and risk management concerns related to perioperative pressure injuries.

SDS: How should perioperative nurses use this toolkit? How could it improve care quality and best practices?

Mellinger: This toolkit can be a catalyst for changing nursing practices for those nurses who are not aware of the problem. Toolkits are designed so that the nurse and other users can review all the content and choose components that will help them address a specific concern at their facility. This toolkit is designed to help the entire healthcare facility prevent the surgical patient’s risk for perioperative pressure injury.

For administrators, there is information for quality improvement initiatives and a sample poster of another healthcare facility’s success in developing a perioperative pressure injury prevention program. The manager, educator, and all perioperative nurses have tools to educate the entire team about safely positioning patients for surgery and strategies to prevent perioperative pressure injuries.

The perioperative nurse can learn about the problem, and is provided assessment, implementation, and evaluation tools for use in clinical practice.

SDS: What do you believe is the most important part of this toolkit?

Mellinger: All surgical patients are at risk for perioperative pressure injuries. Surgical patients are vulnerable during surgery. They cannot speak for themselves; they cannot reposition themselves once anesthesia has been administered.

This toolkit provides resources to the perioperative team as well as healthcare administrations about the problem of perioperative pressure injury and offers solutions to inform the team, prevent harm, and reduce the incidence of perioperative pressure injury events.

SDS: To what extent are pressure injuries a problem in the operating room?

Spruce: The Agency for Healthcare Research and Quality states that more than 2.5 million people in the United States develop pressure injuries every year.2 These are associated with longer hospital stays and increased morbidity and mortality. The National Pressure Injury Advisory Panel estimates that pressure injury incidence directly attributable to the operating room ranges between 4% and 45%. Typically, a pressure injury attributable to surgery develops between several hours to three to five days.1

Patients undergoing surgery are at increased risk for a pressure injury because they are immobile, positioned on hard surfaces, are not able to feel pain or discomfort, and are unable to change their position during surgery. They are immobile during the preoperative period and often remain that way until they are waking up in the recovery room. These risks, along with individual patient factors such as age, comorbidities and nutritional status, all combine to increase a surgical patient’s risk of developing a pressure injury.

It is extremely important for perioperative team members to evaluate every patient for the degree of risk for developing a pressure injury and implement preventive strategies. 


  1. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers/injuries: Quick reference guide. 2019.
  2. Agency for Healthcare Research and Quality. Preventing pressure ulcers in hospitals: A toolkit for improving quality of care.