The number of patients suffering from pressure injuries sustained in a healthcare setting is staggering. According to recent estimates, more than 2.5 million patients in acute care facilities develop pressure injuries annually. Of those, 60,000 will die from related complications.

As hospitals strive to bring those numbers down, it is important to implement protocols with rigor and consistency. That goal inspired the development of the CMUNRO SCALE.

Cassendra Munro, MSN, RN, CNOR, previously created the Munro Pressure Injury Risk Assessment Scale for Perioperative Patients. The instrument determines a risk level score for each patient, giving staff a clear sense of the proper course of care.

To be sure the instrument is being used correctly, Munro created the CMUNRO SCALE, a mnemonic education device to help instruct nurses and other healthcare staff on the signifiers than require their attention in the prevention of pressure injuries. Munro also worked with Mizuho OSI on how to proactively flag areas of risk using their solutions in the surgical suite.

“The CMUNRO SCALE spells out in chronological order the risk factors assessed in the preoperative, intraoperative, and postoperative phases of care,” explains Munro. “These are the same risk factors that are listed in the Munro Scale when we calculate risk level.”

Factors such as comorbidities, body mass index, and mobility figure into the Munro Scale. The CMUNRO SCALE offers a valuable reminder to staff, prompting them to engage in the evaluative process while working with patients. The letters correspond to measures staff should evaluate to determine likelihood of pressure injuries developing. For example, the M stands for “Mobility” and the N stands for “Nutrition”.

By following the evaluative steps, nurses are alerted to those patients most prone to pressure injuries and who therefore require additional attention.

“We cannot implement preventative measures if we don’t identify those who need them,” says Munro, noting that prevention is far more cost-effective than reactive treatment.

“What’s happening now is our patients who undergo surgery are being evaluated using a non-surgical risk assessment scale that deems them not at risk, so preventative measures are being missed,” Munro continues. “We need to fill in the communication gap that happens when the patient leaves the perioperative area. Prevention should not stop just because the procedure has ended.”

The Munro Scale bridges the gap between treatment and recovery, providing added protection for the patient. It is built upon an accumulation of scoring through the perioperative experience, a dynamic feature that makes it highly unique among risk assessment instruments. The Munro Scale reflects the reality of the patient experience, which is based on the total care journey rather than components that are distinct and disconnected.

Even as the Munro Scale is adaptive to the ongoing patient experience, it provides a platform for standardized care, especially when the CMUNRO SCALE is used as a teaching guide. No matter who is looking after a patient, the attention to detail is uniform.

“When you have a standardized approach, that means every patient receives the same quality of care, regardless of the number of years of experience that a nurse may have,” says Munro. “If we use standardized risk assessment instruments, then everyone is treated equally and they get the same safe patient care.”

The Munro Scale and CMUNRO SCALE teaching tool are available as part of the AORN Prevention of Perioperative Pressure Injury toolkit.