The Pressure Is On! An Innovative Approach to Address Pressure Ulcers in the ED Setting

Bjorklund, Linda; Basch, Alice; Borregard, Betsy; Brown, Beth; Denno, Jennifer; Montgomery, Emy; Pedicini, Kathryn; Saporito, Jo

doi:10.1016/j.jen.2010.12.013

Cited by 6 publications

(14 citation statements)

References 14 publications

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“…In the time-pressured environment of the ED, it may be useful to use a risk assessment scale to identify those at greatest risk of developing a PI, so that pressure-relieving devices can be used discriminately; however, further research is needed in this area. Use of a shorter version of a risk assessment tool for screening at triage has been previously studied in the USA 16 and found to improve reporting quality and raising of ED staff awareness of the importance of PI prevention 16 ; this may be useful for prehospital and ED contexts and is recommended for further research. Supportive education has previously been found to improve identification and correct classification of PI in the ED setting, 35 which may improve efficiency of ED risk assessment.…”

Section: Discussionmentioning

confidence: 99%

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

Fulbrook

Miles

Coyer

2019

Australian Critical Care

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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.

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Section: Discussionmentioning

confidence: 99%

“…At-risk patients who remain on non-pressure-relieving surfaces in the ED are at increased risk of PI development. 16 All these factors could contribute to development or progression of PI for an ED patient.…”

Section: Introductionmentioning

confidence: 99%

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

Fulbrook

Miles

Coyer

2019

Australian Critical Care

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“…Systematic and accurate examination at the time of admission is needed. However, careful assessment may be difficult to achieve due to other urgent care issues but, if omitted, may lead to significant overestimation of the PI incidence attributable to care in the institution. The use of data derived solely from clinical records (rather than planned prospective data collection) may limit the ability to verify if the reported PIs were hospital‐acquired …”

Section: Measurement Related Challengesmentioning

confidence: 99%

Pressure injury identification, measurement, coding, and reporting: Key challenges and opportunities

Weller

Gershenzon

Evans

et al. 2017

International Wound Journal

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Pressure injury (PI) rates are a commonly used indicator of performance of health care facilities, both in acute and subacute settings. However, measuring PI rates in an accurate and reproducible fashion has been challenging. The consequences of poor measurement may include failure to identify poorly performing institutions or incorrect accusations of poor quality care. In this article, we describe the main challenges in identification, coding, and reporting of PIs. Issues include inconsistent identification of PIs at the time of admission, variations in the intensity of PI detection, and differing approaches to coding and the adjustment for differing risks amongst different patient population. These are compounded by differences in the epidemiological approach because rates will differ according to whether patients are surveyed cross-sectionally (eg, on a set day per month) or if the survey is undertaken at discharge. In some cases, financial incentives may also influence PI reporting. We also discuss potential strategies for improving data collection and benchmarking as an aid to reducing PI prevalence.

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“…Variation in standards of care means that they are a significant cause of unnecessary patient suffering and mortality, avoidable hospital admissions and onerous costs for health services (Padula and Pronovost 2018). A growing body of evidence demonstrates the critical role of emergency departments (EDs) in preventing pressure ulcers (Denby and Rowlands 2010, Bjorklund et al 2011, Faulkner et al 2015, yet it appears that few EDs have prevention protocols in place (Gefen 2008, Gamston 2019.…”

Section: Introductionmentioning

confidence: 99%

Preventing pressure ulcers in emergency departments: four simple and effective nurse-led changes

Stanberry¹,

Lahti²,

Kevin³

et al. 2021

Emergency Nurse

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Patients can develop pressure ulcers within a few hours of entering an emergency department (ED). However, despite the critical role of EDs in reducing the incidence of pressure ulcers, few have protocols in place for prevention. This article describes the prevention emergency project (PEP), a quality improvement project undertaken in the ED at Karolinska University Hospital in Sweden to reduce the incidence of pressure ulcers. The article demonstrates how four simple nurse-led changes -early risk assessment, pressure-relieving equipment, intentional rounding, and using prophylactic dressings and incontinence pads -can reduce the incidence of pressure ulcers significantly when integrated into ED workflow.

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The Pressure Is On! An Innovative Approach to Address Pressure Ulcers in the ED Setting

Cited by 6 publications

References 14 publications

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

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

Pressure injury identification, measurement, coding, and reporting: Key challenges and opportunities

Preventing pressure ulcers in emergency departments: four simple and effective nurse-led changes

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