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 on inpatient units. They found that PIs were often associated with prolonged ED stays, in many cases more than 12 hours.

Nurse-led team achieves significant decrease in PIs.

The EBP team worked with ED staff to develop protocols and education materials, standardize assessments, and secure supplies that ED staff hadn’t had access to. There was also some restructuring of ED staffing so float nurses could be assigned to care for patients waiting for admission over long time periods. And while boarding times after the EBP intervention were still high, the incidence rate of PIs decreased significantly.

In addition to causing patients pain, prolonging hospital stays, and increasing costs, PIs are considered “never events.” This article shows how nurses from different hospital areas came together to markedly reduce these preventable adverse events with thoughtful and evidence-based nursing interventions. You can read it for free until March 1.