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GENERAL PURPOSE: To present the details of a quality improvement project designed to define and provide best practices in surgical patient positioning and transfer processes with the surgical spine table.


LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, you should be able to:


1. Summarize the purpose and the goals of the authors' quality improvement project focused on best practices in surgical patient positioning.


2. Describe the methodology the authors used in designing their quality improvement project.


3. Analyze the results of the project and implications for practice.



1. According to the Association of periOperative Registered Nurses, patients having procedures that last more than three hours are at what level of risk for pressure injury (PI) development in the operating room (OR)?


a. low


b. moderate


c. high


2. How much reimbursement from the Centers for Medicare & Medicaid do facilities receive for hospital-acquired stage III and IV PIs?


a. none


b. partial


c. total


3. Spinal fusion prone procedures can create an additional risk of skin integrity issues because they cause


a. sustained abdominal pressure on the hard surface of the OR table.


b. circulatory compromise from tight application of the positioning straps.


c. friction of the patient on the table top and against the positioning straps.


4. For a nonmobile, conscious or unconscious patient, general guidelines from the Association of Surgical Technologists Education and Professional Standards Committee require a minimum of how many team members?


a. two


b. four


c. six


5. Which of the following features of the spinal table secure the table top to the Jackson spine table frame?


a. T-pins


b. table brakes


c. safety straps


6. DiPaola and colleagues noted that the log-roll technique requires one staff person to secure the patient's head, two to move the midsection, and one


a. to stabilize the table.


b. for each leg.


c. for the feet.


7. Which of the following steps in the authors' implementation of their quality improvement project using the Define, Measure, Analyze, Improve, and Control framework included surveying the surgical staff regarding their confidence for the safe completion of prone positioning?


a. Define


b. Measure


c. Analyze


8. During the Define step of the quality improvement project, the authors


a. partnered with the institution's ergonomics team to help understand opportunities to improve the flip process.


b. developed a checklist to ensure patients' safety through an equipment check at each Jackson table use.


c. conducted a literature review to assess current research and information on the flip practice.


9. Which of the following steps in the authors' implementation of their quality improvement project using the Define, Measure, Analyze, Improve, and Control framework included benchmarking to help determine current practice and the commonalities toward a best practice process?


a. Define


b. Measure


c. Analyze


10. During the Control step of the quality improvement project, the authors


a. identified a team leader who conducts an audible and visual pause with all members of the surgical team before a patient transfer.


b. monitored the process by analyzing patient events as tracked in the electronic patient record in the nurse charting application.


c. developed videos and simulations to support staff in adapting and adhering to the new equipment use standards.


11. Which of the following terms refers to placing the patient between the top and bottom pieces of the Jackson table for a turn in place?


a. sandwiched patient


b. patient flip


c. receiver


12. Which of the following terms refers to the person with the role of catching the patient during the flip?


a. sender


b. receiver


c. head supporter


13. For the quality improvement project, internal benchmarking specifically included looking at equipment use, the replacement and repair process, and


a. examination of skin integrity issues with use of a viscoelastic foam mattress during surgery.


b. exploration of suggested guidelines for the flip process in spine surgeries.


c. comparison between the orthopedic and neurosurgical spine practices.


14. According to respondents to the REDCap survey, the most physically demanding role in the patient flip was that of the


a. sender.


b. receiver.


c. head supporter.


15. Respondents to the REDCap survey indicated that the riskiest phase of the patient flip was


a. head holding and stabilization.


b. managing the head frame system.


c. adjusting and lifting any part of the patient's body.


16. The mnemonic444referred to 4 transfixion pins on the top, 4 transfixion pins on the bottom, and


a. 4 staff members performing the flip.


b. 4 safety checks before flipping the patient.


c. 4 safety belts for both the mechanical flip and the manual flip.


17. Since the inception of the quality improvement project, recent data showed a 37% decrease in skin integrity events in which bodily area?


a. hip


b. chest


c. buttocks


18. Of OR-reported skin integrity issues in data from April 2012 through April 2013, the most common site for these issues was the


a. chest.


b. back.


c. knees.