Converging developments in the medical and legal arenas are leading to new standards of care for prevention of operating room (OR)-acquired pressure ulcers. Surgeons and other OR personnel are increasingly aware that OR-acquired pressure ulcers are not uncommon. They now understand that many pressure ulcers first identified several days after surgery in fact originated in the OR, and that many lesions previously mis-characterized as chemical or electrocautery burns actually represented Stage I pressure ulcers.
This new knowledge is coupled with increasing recognition that pressure ulcers are usually preventable, and that development of a pressure ulcer commonly represents a failure of medical or nursing care. Further, preliminary results of ongoing clinical studies suggest that routine intraoperative and postoperative use of a specially designed dynamic patient support surface is effective in reducing the incidence of pressure ulcers in high-risk surgical patients.
Attorneys, too, closely follow developments in this area. Several well-publicized multimillion dollar verdicts against health care providers who failed to prevent or adequately treat pressure ulcers have attracted widespread attention among the plaintiff's bar. In the current climate of for-profit medicine, law is widely regarded as an essential patient safeguard against excessive cost cutting by health care providers.
Courts increasingly are assigning responsibility to hospitals, as well as to physicians and nurses, for episodes of malpractice occurring within the hospital. They require hospitals and physicians to comply promptly with evolving standards related to patient safety and protection in the OR. In order to determine appropriate standards, the courts turn to medical experts, practice guidelines, governmental regulations, and pronouncements of specialty societies. When dissatisfied with these sources, courts themselves have even established new standards as a rule of law. Juries frequently are angered by corporate emphasis on profit at the expense of safety, awarding substantial punitive damages to injured plaintiffs. Health care providers have even been prosecuted criminally for fraud or neglect related to pressure ulcers.
At this time, surgeons, anesthesiologists, OR nurses, and hospital administrators should be aware that OR-acquired pressure ulcers are a significant problem. This awareness creates an obligation to utilize reasonable, available measures to prevent their occurrence, and to monitor closely new developments in pressure ulcer prevention.
