Background: Hospital acquired pressure injuries (HAPI) are preventable skin injuries that can lead to increased lengths of stay and greater treatment costs. A Maryland hospital reported 122 HAPIs for FY23. Contributing factors included increased emergency department (ED) boarding times with delayed skin assessments. The ED managed 1,410 boarding patients in FY23, amounting to 44,234 boarding hours. Knowledge: Research shows a correlation between HAPI incidence and ED boarding time, indicating early skin assessment and prevention should begin in the ED. Objective: This QI project explored increasing identification and documentation of pressure injuries (PI) present on admission (POA) by implementing an electronic skin assessment bundle for ED boarding patients, thereby improving HAPI rates. Methods: The project lead (PL) met with ED leaders to review PI documentation, determining an accessibility barrier with certain fields within the electronic medical record (EMR) for ED registered nurses (EDRNs) to capture PI POA. The PL collaborated with an analyst to create a documentation bundle within the EMR, consisting of a skin assessment, Braden scale, and skin abnormalities sections. A rule generated a task at admission, while patients remained in the ED. Education was created for the new bundle, highlighting evidence-based PI education, and disseminated to all EDRNs. Bundle completion was measured through an electronic report, indicating total bundle tasks fired and documented completions. Results: 100% of EDRNs received education (n=79). The bundle task generated for 100% of patients admitted through the ED (n=5,094). Focused education and continued rounding improved documentation of both Braden and skin abnormalities. There was an overall 17% bundle completion rate, with 38% of Braden scores <18 and 67% of skin abnormalities documented on boarding patients. The number of documented PIs POA has increased with a decrease in mislabeled HAPIs, indicating project success. Conclusions: This QI project showed improvement in early PI identification and documentation with an electronic skin assessment bundle by tasking nurses to complete while patients remained in the ED. Incorporating this EMR technology at a significant point of entry, such as the ED, advances clinical nursing practice and enhances patient safety by capturing the skin assessment earlier in the patient stay.