Gradient warning nursing procedure reduced pressure ulcers in prone orthopedic surgery patients.

Pressure ulcers are recognized as a prevalent intraoperative complication in prone-positioned orthopedic surgery patients. This study aimed to explore the effects of a gradient warning nursing procedure (GWNP) guided by the Pressure Injury Risk Factor Assessment Scale (PIRFAS) and ultrasonography on pressure ulcers in prone-positioned orthopedic operation patients. This retrospective cohort study enrolled 126 patients who underwent prone-positioned orthopedic surgery at our hospital between May 2022 and May 2024. The assignment to groups was based on a hospital-wide implementation of a new nursing protocol on 1 June 2023. Accordingly, 60 patients admitted before this date constituted the regular group and received regular care, while 66 patients admitted on or after this date constituted the joint group and received the gradient early warning nursing procedure guided by the Pressure Injury Risk Factor Assessment Scale (PIRFAS) and ultrasonography, in addition to regular care. The incidence of pressure ulcers, pressure ulcer grading, number and area of injury, simplified comfort status scale (GCQ) pre- and post-care, hospitalization duration, and costs were collected and compared between the two groups. Statistical analyses were performed using SPSS 25.0, with the χ2 test, independent samples t-test, Mann–Whitney U-test, and multivariate regression analysis being employed as appropriate for data types and comparison purposes. The results in our study revealed that the incidence (adjusted odds ratio [aOR: 0.11], 95% CI: 0.02–0.48), number (adjusted mean difference [aMD: −0.82], 95% confidence interval [CI]: −1.04 – −0.60), area (aMD: −0.62, 95% CI: −0.83 – −0.41), and grading of pressure ulcers were significantly decreased in the joint group versus the regular group (p 0.05), whereas the GCQ scores regarding physiological (aMD: 3.32, 95% CI: 2.45–4.19) and psycho-spiritual (aMD: 2.23, 95% CI: 1.38–3.08) aspects in the joint group post nursing were evidently higher versus the regular group (p  The GWNP guided by the PIRFAS and ultrasonography could effectively represent an effective bundled intervention for prone-positioned orthopedic surgery. Implementation of this protocol in clinical practice can potentially enhance patient safety by reducing pressure ulcer incidence and severity while also improving healthcare resource utilization. Future research should focus on validating these findings through multicenter randomized controlled trials.