Initiating Pressure Ulcer Prevention in the High Risk Population of the Emergency Room

Purpose:
Pressure ulcers can develop in as little as 2 hours. Average length of stay in the ED is 3 hours and can be longer than 24 hours for some patients. Identification of high risk patients and the implementation of pressure ulcer prevention is a priority in the ED setting.

Significance:
Identifying high risk patients for skin break down and implementing evidence-based prevention strategies provides early intervention. Pressure ulcers(PU)have been identified as one of the top three in-hospital errors that lead to patient deaths. PU patients have 2-6 times greater mortality.

Strategy and Implementation:
An Algorithm was designed specifically for identifying high risk patients for pressure ulcers(PU)in the ED. An educational program was created and implemented for all nurses and all shifts in the ED. The education provided covered topics such as: skin assessment, Medicare reimbursement changes for acquired PU vs. Present on admission(POA), PU prevention of progression of present on admission(PU's),the use of the Braden Scale in the ED, pressure ulcer staging and treatment,and nurse initiated prevention strategies following hospital approved patient care protocols. A tool was created to track patients in the ED that were put on a static overlay air mattress. This tool was utilized to extrapulate data to implement an IRB approved nursing research study focusing on the use of static overlays in the ED and the prevention of PU's. The early interventions started in the ED based on the Braden Scale were continued after hospital admission maintaining the patients continuity of care.

Evaluation:
Utilized post-test to validate post seminar knowledge in the ED nurses. Monitored compliance of evidence-based skin assessment and prevention strategies through documentation. Following IRB approval for the 3 ED's in our system, Our data is currently under outcome analysis.

Implications for Practice:
The ED nurses successfully obtained knowledge of evidence-based practices and easily integrated the assessment and intervention for high risk patients. Our research study will validate ED nurse compliance and contribution to the reduction of hospital aquired PU's, which was never published before.