Date on Paper


Document Type

Doctoral Paper



Committee Chair

McRae, Emily

Committee Member

Galloway, Lynette

Author's Keywords

pressure injury prevention; knowledge enhancement; documentation compliance; intra-operative patient positioning; chart audit; circulator


Background: 1,600,000 patients develop a hospital-acquired pressure injury every year, and 23% of these originate during surgery. Research has demonstrated that the incidence of hospital-acquired pressure injuries developing during surgery has risen over the past 5 years. This rise has been attributed to nurse circulators exhibiting poor knowledge regarding best practices for intraoperative patient positioning and intraoperative documentation that does not follow standards of care.

Purpose: This quality improvement project aimed to enhance circulator knowledge on best practices for intraoperative patient positioning and improve documentation of intraoperative patient positioning in the electronic medical record to comply with standards of care.

Intervention: Circulators completed a self-directed learning module on intraoperative patient positioning. Enhanced knowledge was assessed using a pretest-posttest study design. A concurrently implemented, but unrelated, intervention was a visual checklist that featured positioning elements for intraoperative documentation and placed throughout operating rooms on circulator used computers. Compliant documentation was measured via chart audit 2 months pre- and post-intervention.

Results: The mean rank of postintervention test scores rose 15.75% compared to the preintervention test scores, a statistically significant result, (U = 88.50; p < .001). The mean number of positioning elements recorded postintervention (6.77) was greater than preintervention (5.94).

Discussion: Self-directed learning modules led to enhanced knowledge and should be utilized to educate new and reeducate veteran circulators on intraoperative patient positioning techniques at this site and other facilities. Visual checklists displaying positioning elements should be referenced by circulators when recording patient positioning in the electronic medical record. Sporadic chart audits should be employed to increase documentation compliance.

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