Pressure Injury Prevention in Patients with Prolonged ED Stays Prior to Admission

Abstract

Purpose: The purpose of this project was to examine whether initiating a standardized pressure injury (PI) assessment and prevention protocol early in adult patients' ED stay reduces hospital-acquired PIs (HAPIs) in those patients admitted from the ED to acute care inpatient medical units. Methods: A nurse-led evidence-based practice team studied the problem of increasing HAPIs on four acute care inpatient units and found that, among patients who had been admitted to inpatient care from the ED, longer ED boarding times correlated with a higher rate of HAPIs. ED staff and acute care unit nurses collaborated to develop new protocols to prevent HAPIs in the ED, including staff education and standardized assessments and prevention care for at-risk patients. Data collection was performed at three time periods over approximately two and a half years: baseline, intervention, and postintervention. Results: The incidence rate for HAPIs decreased from 3.56 per 1,000 patient-days at baseline to 1.31 per 1,000 patient-days during the intervention period. This reduction was sustained over the next five months, during which the HAPI incidence rate was 1.53 per 1,000 patient-days. Implications: At a time when ED length of stay is difficult to manage and continues to increase, the use of evidence-based interventions and protocols can reduce the rate of PIs in high-risk patients waiting for hospital admission, leading to a reduction in PI rates and overall hospital costs.

Pressure injury screening in the emergency department: A concept analysis

“…Global HAPI rates have been between 3% and 19.7% 12 . Over the past two decades, the types of patients presenting to the ED have changed; patients are older and have more comorbidities 13 . Due to the increased lengths of stay in the ED, implementing PI screening at first contact is presumed to positively affect the hospital's HAPI rate.…”

“…The comorbidities linked to PI development are diabetes, a hypo‐perfused state, hypotension, and spinal cord injuries 3 . The positive consequences of pressure injury screening in the ED are increased patient comfort, increased staff satisfaction, decreased HAPI rates, decreased costs related to PI management, and increased adherence to protocols 13 . A potential negative consequence of pressure injury screening in the ED is the perception of the ED nurse that the addition to the screening and management adds to the already cumbersome workload 19 …”

“…Measurable empirical referents of pressure injury screening in the ED are an overall reduction in the hospital HAPI rate and that 100% of patients are screened in the ED, regardless of their disposition. Literature demonstrated a 72% reduction in HAPI rates with the implementation of PI screening in ED boarder patients 13 . However, limited studies exist in the body of literature that have studied pressure injury screening in the ED.…”

“…Literature demonstrated a 72% reduction in HAPI rates with the implementation of PI screening in ED boarder patients. 13 However, limited studies exist in the body of literature that have studied pressure injury screening in the ED. Even fewer have studied the effect that early screening in the ED has on HAPI rates.…”

Content Validation of an Emergency Department Skin Risk Assessment Instrument

“…Focused skin assessment in the ED therefore presents an opportunity for early evaluation and intervention for at-risk patients, as well as for identification of preexisting PIs. It is essential to carefully assess for PIs and implement safety strategies to protect patients from adverse events beginning at the point of entry into the organization, including during urgent care situations (Edwards et al, 2021; Weller et al, 2018). When the risk is determined to be high or a PI is already present, appropriate measures must be taken to mitigate initial or further PI development.…”