Running head: NON-SLIP PADS DURING SURGERIES REQUIRING 1

Non-Slip Pads during Surgeries Requiring Trendelenburg

Rebecca Nappi

Bon Secours Memorial College of Nursing

Business of Health Care in Complex Systems

NUR4240-201617-SP

Catherine Mikelaites MSN, RN-BC, CMSRN

February 18, 2017

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Non-Slip Pads during Surgeries Requiring Trendelenburg

Robotic gynecological surgeries require the patient to be placed in steep Trendelenburg

while also being in lithotomy position. This creates a unique challenge for the operating room

staff to position the patient in a way that will prevent any nerve damage and keep the patient

from sliding off the top of the bed while keeping the entire abdomen and perineum fully exposed

for the surgeon to operate. There have been many advances in patient positioners over the years

but many of these products become very expensive when using only one per patient. This type of

cost is not something you can bill the patient for but rather is part of the overall operating room

cost to have surgery. This detail is why my hospital desire to keep the cost of the product as low

as possible while ensuring patient safety.

Process

I am the robotic and gynecology team lead for St. Francis operating room. This position

allows me to be present during many surgeries requiring steep Trendelenburg positioning. I have

firsthand experience with patients moving on the operating room table during a 5-6 hour surgery

requiring head down positioning. It can cause very serious injuries, from trocars in the abdomen

tearing tissue, skin tears on the patient’s back or shoulder to even nerve damage from pressure

areas (Kilic, Ertan, & Kose, 2014). I first gathered my initial data from surgeries I was the

circulator in. I then contacted other hospitals in the area to ask them what they use and why. I

also contacted the rep for these products that were being used and asked them to send me data on

patient safety. I also looked up AORN (association of operating room nurses) standards and

recommendations to gather further information (Hortman & Chung, 2015). One challenge I

encountered during this process was finding accurate pricing due to contracts with companies
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making the pricing vary so much. Overall, between the internet, my nurse manager and reps from

companies it was a straight forward process gathering needed information.

Presentation

Finding pictures that accurately represent the items in consideration for presentation was

a little difficult. Deciding which areas to focus on for direct reasoning for wanting this change

was difficult for me because I sometimes get bogged down with too many details instead of just

focusing on one or two main topics. For example, infection prevention is my main reason for

suggesting this improvement but I got distracted with pricing and then the appearance of the

different pads for patient satisfaction which took me away from the focus of infection prevention

which the surgeons I am presenting to will care the most about when considering a change.

Reflection

The main take away lesson for me from doing this project was realizing what goes into a

product change or a process improvement. The staff griping and expressing their opinions about

how it causes extra steps for them was very difficult for me to handle. The patient is the only one

that counts and if a product helps a patient then each team member should be excited and ready

to embrace that change but instead I found myself trying to convince co-workers that what we

had been doing for years was ok but now we are aware of better options. We have a low

infection rate at my hospital so every time I presented this change I met resistance from staff

because they did not want to fix something that was not broken. My respect and thankfulness for

those in management has grown greatly.

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References

Hortman, C., & Chung, S. (2015). Positioning Considerations in Robotic Surgery. AORN.

Retrieved from https://www.aorn.org/websitedata/cearticle/pdf_file/CEA15539-0001.pdf

Kilic, S., Ertan, K., & Kose, M. (2014). Patient Positioning, Trocar Placement, and Docking for

Robotic Gynecologic Procedures. In Robotic Surgery: Practical Examples in Gynecology

(pp. 37-48). Retrieved from

https://books.google.com/books?hl=en&lr=&id=QdLmBQAAQBAJ&oi=fnd&pg=PA37

&dq=lithotomy+trendelenburg+positioning+surgery+with+tape&ots=d8R1n5A-

PU&sig=KC6BMQhs3hgIyEtUmM3pIX53dvE#v=onepage&q=lithotomy%20trendelenb

urg%20positioning%20surgery%20with%20tape&f=false