Date of Award

Summer 2022

Document Type

Final DNP Paper

Degree Name

Doctor of Nursing Practice (DNP) in Adult-Gerontology Acute Care Nurse Practitioner



Faculty Chair

Dr. Heather Wallace


Background: The process of implementing appropriate skin assessment and documentation throughout the patient’s operative experience assists in the early detection of pressure ulcers.

Purpose: This Doctor of Nursing Practice (DNP) project had two goals. The first was to determine a practical tool that would ensure that surgical nurses demonstrate competence and comply with the process of identifying compromised skin integrity, and the second goal was to effectively communicate the findings with other clinical team members.

Methods: The DNP project focused on the use of the Munro Pressure Ulcer Risk Scale Assessment Tool to identify pressure ulcers and to promote collaboration among the surgical team, the physician, and the wound care specialists.

Results: There was a 75% increase since 2021 in completing the intra-operative portion of the Munro Assessment Tool after educating the surgical nurses. The post-operative portion of the assessment tool addresses the length of surgery (LOS) and the estimated blood loss (EBL), which remained at zero. However, the nurses explained that the surgeon documented the LOS and the EBL in the operative reports, rather than using the assessment tool. After the writer captured the data, the overall total of the patients’ “risk factor score” remained high and placed each patient at risk for developing pressure injuries during surgery.

Conclusions: Compliance rates increased after educating the surgical nurses regarding their responsibilities in completing the intra-operative portion of the Munro Pressure Ulcer Risk Assessment Scale for Perioperative Patients. The compliance rate will likely continue to increase with continued education and the development of a surgical pressure ulcer risk-assessment team.

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