Prevalence of pressure injury in adults presenting to the emergency department by ambulance

Abstract

Introduction: Pressure injuries are harmful, painful, and potentially preventable. Although hospital-acquired pressure injury prevalence is decreasing, it is unclear if some pressure injuries develop before hospital admission. The objective of this study was to investigate the prevalence of pressure injury in adults on arrival by ambulance to the emergency department (ED). Methods: An observational, cross-sectional descriptive study design was used. Participants (n ¼ 212) were recruited from the EDs of two Australian tertiary hospitals. Full skin inspection and pressure injury risk assessment, using Braden and Waterlow scores, were undertaken within 1 h of presentation. Results: Pressure injuries were identified in 11 of 212 participants, giving a prevalence of 5.2% at presentation. Nearly all were admitted to hospital, giving a prevalence of 7.8% at this entry point. Participants with pressure injury and those at high risk of injury were found to have spent longer in the ambulance and within the ED. During ambulance transport and in the first hour of presentation to the ED, it was rare that pressure-relieving interventions were implemented, even for those with an identified pressure injury and those at high risk. Conclusions: The results indicate that early pressure injury surveillance and risk assessment are merited at the point of presentation to the ED, so that prevention and treatment can be implemented at the earliest possible opportunity. Although it is more challenging to manage pressure injuries within the ambulance and ED, the use of pressure-relieving devices should be considered for those at greatest risk. Further research is recommended.

International consensus on pressure injury preventative interventions by risk level for critically ill patients: A modified Delphi study

“…One study suggests that skin assessment at the least should be undertaken at point of entry to hospital care. 61 It would appear that this view is supported by the results of this study, with consensus indicating that risk assessment should be undertaken within 2 hours of intensive care admission. This is particularly pertinent given critically ill people are acutely vulnerable to PI development.…”

“…Thus, it has been argued that interventions should be planned and implemented as soon as possible, 22 and risk assessment is required at the earliest opportunity to inform intervention use. One study suggests that skin assessment at the least should be undertaken at point of entry to hospital care 61 . It would appear that this view is supported by the results of this study, with consensus indicating that risk assessment should be undertaken within 2 hours of intensive care admission.…”

Relationship Between Prescription and Documentation of Pressure Injury Prevention Interventions and Their Implementation: An Exploratory, Descriptive Study

“…This may occur, for example, when a patient is unable to move themselves while lying in a hospital bed, resulting in sustained force being applied to the areas of the body touching the bed surface (Gillespie et al, 2014;Krapfl & Gray, 2008). Given that this force may result in PI development, the application of PI preventative measures during the early stages of hospital admission is crucial for patient safety (Fulbrook, Miles, & Coyer, 2019).…”

“…Various factors are associated with PI risk, such as older age, limited mobility, perfusion impairments, and poorer nutritional status, with combinations of such factors potentially contributing to the overall PI risk in an individual patient (Coleman et al, 2013). The risk assessment must be undertaken as soon as possible after admission to a healthcare facility, including following entry via the emergency department (Fulbrook et al, 2019).…”

Monitoring and alleviating the effects of pressure related injuries for spinal surgery–a need for improvement?

“…If PIs were documented throughout the intraoperative process, clinicians could potentially prevent the onset of this debilitating complication. There is evidence to suggest that prevention is more effective than treatment 9 in the form of a device and human intervention. Schuurman et al 10 suggest both strategies are equally effective at preventing PIs.…”