pressure ulcers Archives - Off the Charts

Improving the Discovery and Care of Pressure Injuries in the Emergency Department

Jonathan Nover, MBA, RN

The problem.

Hospital-acquired conditions, particularly pressure injuries (PIs), increased at alarming rates during the COVID-19 pandemic. Hospital isolation precautions and infection prevention practices limited clinician time at the bedside. How does a nurse regularly turn and position a patient if they are unable to enter the room as often as they did prior to the pandemic? In addition, hospitals often operated with high percentages of their workforce out sick.

While Covid may be less of a threat by now, the number of patients admitted to EDs continues to increase while nurse staffing shortages intensify the pressure on nurses to maintain patient safety standards. With patient boarding in EDs becoming more common, the risk of hospital-acquired PIs grows as well, even in the ED. Traditional ED care focuses on rapid screening, assessment, and stabilization, followed by discharge or admission. But the reality is that medical–surgical inpatient care has become more necessary in the ED.

A central element of nursing care is the identification of PIs upon entry to the hospital, PI prevention, and care of existing PIs. Patients who are boarded in the ED, particularly older patient populations with underlying diseases and long length of stays, are at especially high risk for pressure ulcers or […]

Guest Author2022-10-27T11:03:41-04:00October 27th, 2022|Nursing, patient safety|0 Comments

Decreasing ED-Acquired Pressure Injuries

Perfect candidates for developing pressure injuries.

The photos of EDs crowded with patients waiting for admission at the height of the COVID-19 surges brought back many memories of clinical days in Bellevue’s ED. But even on our worst evenings, it was never like what I saw in those photos in the news media. And in some places, the ED hallways still have lines of stretchers with patients waiting to be sent to units.

In busy hospitals, patients can wait hours, sometimes a full day, on stretchers in the ED, waiting to be sent to a patient care unit. And we know that if they are being admitted for inpatient care, they usually have complex medical needs—many of these patients may be unable to ask for help, be incontinent, or unable to move themselves. These patients are perfect candidates for developing pressure injuries (PIs).

PIs can develop in a matter of hours.

As an article in the February issue of AJN notes, pressure injuries can develop in a relatively short time (the authors cite studies that found hospital-acquired PIs can “occur in as little as two hours of unrelieved pressure”).

The article, “Pressure Injury Prevention in Patients with Prolonged ED Stays Prior to Admission,” details how a nurse-led evidence-based practice (EBP) team sought to decrease hospital-acquired pressure ulcers […]

Shawn Kennedy, MA, RN, FAAN, editor-in-chief (emerita)2021-02-16T14:23:23-05:00February 16th, 2021|Nursing|0 Comments

How a Busy Hospital Reduced Its Rate of Hospital-Acquired Pressure Ulcers to Zero

By Sylvia Foley, AJN senior editor

A skin lesion monitoring form accompanies a patient. Photo courtesy of NHCH.

In 2009, when one of the world’s largest cardiac care hospitals experienced a spike in the number of surgeries performed and a corresponding rise in hospital-acquired pressure ulcers, many people were concerned. The hospital—Narayana Hrudayalaya Cardiac Hospital (NHCH) in Bangalore, India—soon initiated a program to address the problem, and nursing superintendent Rohini Paul was tasked with designing and implementing effective preventive strategies. In this month’s CE feature, “Sustaining Pressure Ulcer Best Practices in a High-Volume Cardiac Care Environment,” Paul and colleagues describe what happened next. Here’s a brief overview.

Baseline data showed that, over the five-month observation period, an average of 6% of all adult and pediatric surgical patients experienced a pressure ulcer while recovering in the NHCH intensive therapy unit (ITU). Phase 1 implementation efforts, which began in January 2010, focused on four areas: raising awareness, increasing education, improving documentation and communication, and implementing various preventive practices. Phase 2 implementation efforts, which began the following month, focused on changing operating room practices. The primary outcome measure was the weekly percentage of ITU patients with pressure ulcers.
By July 2010, that percentage was reduced to zero; as of April 1, 2014, the hospital has maintained this result. Elements that contributed significantly to the program’s success and sustainability include strong leadership, nurse and physician involvement, an […]

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Guest Author2017-07-27T14:45:11-04:00August 8th, 2014|nursing perspective|7 Comments

AJN’s September Issue: Care of Incarcerated Pregnant Women, Gun Violence, Pressure Ulcer Guidelines, More

AJN‘’s September issue is now available on our Web site. Here’s a selection of what not to miss.

Loneliness may be linked to multiple chronic illnesses, decline in positive health practices, and increased risk of death, as described in this month’s original research article, “Loneliness and Quality of Life in Chronically Ill Rural Older Adults.” Data from the pilot study described in the article suggest that nurses’ assessment and management of loneliness in this population is vital. You can earn 2.5 CE credits with this article. If you’re reading AJN on your iPad, you can listen to a podcast interview with the author by clicking on the podcast icon on the first page of the article. The podcast is also available on our Web site.

In 2004, only 54% of incarcerated pregnant women received some type of pregnancy care, and the quality of that care varied widely. Pregnant women in prisons face other risks, such as poor nutrition and heavy workloads, and often are required to be shackled during labor, despite laws to the contrary. These practices, as well as implications for nursing practice, policy, and research, are discussed in this month’s CE feature, “Care of Pregnant Women in the Criminal Justice System.” Earn 2.5 CE credits by reading this article and taking the test that […]