OR Manager July 2022 - 9
Patient Safety
Resillience
Continued from page 1
Munro Pressure Injury Risk Assessment Scale For Perioperative Patients - Adult©
Intraoperative Risk Assessment evaluates seven risk factor categories to determine a score of 1, 2 or 3. The sum of the
risk factors plus the Preoperative Munro Score Total results in the Intraoperative Munro Score Total to determine the Level of Risk.
that almost half of surgical patients can
come out with a pressure injury. Her
professor stopped her and asked her
to repeat the surgical patient statistics,
and then she asked Munro: " So what
are you going to do about it? "
This question changed Munro's life.
" I set out to develop, in a scientific fashion
with good scholarly rigor, an instrument
that perioperative nurses could
use to help improve the quality of care
and patient outcomes, " says Munro.
" This has been my gift to you, my passion
and pursuit. "
Research methods
The journey of developing a risk assessment
scale opened Munro's eyes as
to the length of time tool development
takes, she says (sidebar, Development
timeline). The timeline began with idea
conception in 2005 and continues into
the future.
Once Munro conceived of the idea,
she used the Delphi survey method,
which is a process used to arrive at a
group decision by surveying experts in
the field. " This method is used when
you don't have a lot of knowledge about
something that you are doing, " she
says. " You basically want to start off by
gaining the experts' opinions about it. "
The survey was sent out to experts,
suggestions from their feedback were
incorporated into the scale, and then
the survey was sent out again askPhysical
Status / ASA Score
As per anesthesia provider
Anesthesia
Body Temperature
Calculate high/low change
as per anesthesia provider
Hypotension
Calculate SBP high/low percentage
change as per anesthesia provider
Moisture
Skin under patient
Surface / Motion
Positioning aids, warming blanket,
position change
Position
For procedure
1
INTRAOPERATIVE RISK FACTOR SCORE
2
3
Healthy & mild systemic disease, no
functional limitations
1
MAC, Local
1
36.1°-37.8° C Body T° maintained
1
Absent or <10% change in BP
1
Remains dry
1
None/use of blanket over/stationary
1
Lithotomy
Moderate to severe systemic
disease, some function limitation
2
Regional
2
<36.1° or >37.8° (+ or - 2°)
T° fluctuated + or - 2°
2
Fluctuating or 11% to 20% change in BP
2
Some moisture
2
Use of aids/blanket under/stationary
2
Lateral
Moderate to severe systemic disease,
constant threat to life and functionally
incapacitating or ASA >3
3
General
3
<36.1° or >37.8° (+ or - >2°) T°
fluctuated + or - >2°
3
Persistent or > 20% change in BP
3
Pooled or heavy fluid
3
Shearing force/added pressure/
variable position
3
Supine/Prone
Intraoperative Score Subtotal:
Add Preoperative Munro Score Total for a Cumulative Total:
Intraoperative Munro Score Total:
13 = Low Risk
13 - 24 = Moderate Risk
Cumulative Risk Assessment Performed By:
RN Signature:
RN Signature:
Munro Score Level of Risk Communicated To:
Reprinted with permission. Copyright © Cassendra A. Munro.
25 or greater = High Risk
LEVEL OF RISK:
18
6
24
Moderate
Risk
Date:
By:
Date:
Time:
The Munro Scale© Version 2.0
Time:
1
3
3
2
3
3
TOTAL
3
Source: Cassendra A. Munro. Used with permission.
ing for additional feedback. This was
done three times, and consensus was
reached that the Munro Scale did indeed
indicate pressure injury risk in perioperative
patients.
" For the last two of the three rounds
of surveys, we knew we were nearing
completion of soliciting information from
our experts because we started to see
a trend in the same suggestions, " says
Munro. " Now the scale was ready for
implementation. "
Munro also used the Middle Range
Theory as a frame of reference for prevention
as an intervention in the Neuman
systems model. " Risk assessment,
in and of itself, is an intervention
for prevention, " she says. " The Munro
Scale is prevention of pressure injury in
the perioperative setting. "
The emphasis of the Munro Scale is
on assessment of patient risk; it is not
a skin assessment. It is also a documentation
and communication tool.
The patient's risk level is scored for
each phase of surgery (pre-, intra-, and
Continued on page 10
Source: Cassendra A. Munro. Used with permission.
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INTRAOPERATIVE ASSESSMENT
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