Pressure Injury Prevention of At-Risk Adult Patients in the Emergency Department

Abstract

Problem & Purpose: The average adult inpatient hospital acquired pressure injury (HAPI) prevalence in this hospital increased from 5.46% in the fourth quarter 2021 to 12.12% in the first quarter of 2022, 59% (n=13) of which were sacral pressure injuries. Emergency department (ED) boarding times greater than 2 hours have been significantly correlated with HAPIs. Both the increased prevalence of HAPIs and average ED boarding times for 2020-2021 of 6.5 hours justified the need for additional sacral pressure injury prevention starting in the ED. The purpose of this quality improvement project was to document a Braden risk score while patients are in the ED and implement a standardized pressure injury (PI) prevention intervention that targets at-risk (Braden score of < 18) admitted patients, boarding for at least six hours in the ED through the application of a prophylactic sacral foam bordered dressing. During the week prior to implementation only 15% (n= 6) of at-risk patients received the intervention and 67% (n=60) of admitted at-risk patients had Braden scores calculated while in the ED. Methods: In the two months prior to implementation, staff were educated about the increase in hospital wide HAPI prevalence, the needed intervention and appropriate documentation. The sacral dressings were relocated from the stock room to inside the patient care rooms and restocked each shift. A weekly electronic health record (EHR) report identified patients in the ED whose first documented Braden scores were <18. These charts were audited in the EHR for first documented Braden scores completed in the ED and prophylactic use of the sacral dressing. Results: Results from weeks 1 though 15, suggested that there was an 18% increase in the number of patients who received prophylactic sacral dressings and a 5% increase in the number of admitted at-risk patients had PI risk scores documented in the ED. Conclusions: The findings suggested that education, identification of PI risk and implementation of a standardized intervention for boarding patients in the ED, enabled PI prevention to start before admission.