Contreras, Jicenda, BSN, RN

Digirolamo, Joseph, BSN, RN

Roses, Alicia, BSN, RN

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksPatient Care Services / NursingTaking the Pressure Off in the EmergencyDepartmentJicenda Contreras BSN, RNLehigh Valley Health Network, Jicenda_B.Contreras@lvhn.orgJoseph Digirolamo BSN, RNLehigh Valley Health Network, Joseph_B.Digirolamo@lvhn.orgAlicia Roses BSN, RNLehigh Valley Health Network, Alicia_D.Roses@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/patient-care-services-nursingPart of the Nursing CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtContreras, J., DiGirolamo, J., Roses, A. (2015, July 8). Taking the Pressure Off in the Emergency Department. Poster presented at LVHNUHC/AACN Nurse Residency Program Graduation, Lehigh Valley Health Network, Allentown, PA.TAKING THE PRESSURE OFF IN THE EMERGENCY DEPARTMENT Jicenda Contreras BSN, RN Joseph Di Girolamo MBA, BSN, RN Alicia Roses BSN, RN Purpose       ▪Project Purpose:  •To identify and prevent pressure ulcers in at risk patients being admitted into the hospital from the Emergency Department PICO QUESTION   ▪ PICO Question – In all adult patients presenting in the Emergency department, does the implementation of a prompt skin assessment (initial skin assessment and reassessment prior to inpatient admission) result in a increase in reportable skin breakdown compared to standard protocol? • P- All adult patients presenting to the Emergency Department  • I- Initial skin assessment and reassessment prior to inpatient admission • C- Standard protocol(assess within two hours of hospital admission) • O- Increase in reportable skin breakdown incidents EVIDENCE  ▪ Emergency Department duration of stay ▪ Populations at risk ▪ As per HBI, there is a total of 858 pressure ulcers reported in the past 24 months for CC and Muhlenberg ▪ As per RL solutions reporting system for the month of February 2015, 118 pressure ulcers were reported • 85/118 were reported present on admission(POA) or present when admitted from another facility – Of that 85, 49 were reported from the ED – 12-CC – 36-EDM – 1-ED 17TH   Current LVHN Policy ▪ No specific policy for LVHN Emergency Department ▪ What is currently being done in the ED • Skin inspection within two hours of admit • Submission ET/PT/Wound healing Team Consult • PSR ▪ Noted inconsistency with skin inspection documentation BARRIERS & STRATEGIES ▪ Barrier: • ED overcapacity  • Admission holds in the ED • Lack of reassessment • Lack of knowledge • Lack of time and resources for preventive measures ▪ Strategy to Overcome: • Prompt skin assessment • Identify at risk patients • Removal of pt clothing during ED visit • Reassessment of admitting patients • Proper hand off communication     Expected Outcomes  ● _Focused approach to pressure ulcer prevention ● _Increase reportable skin breakdown ● _Alleviate hospital financial cost PROJECT PLANS ▪ Prompt skin assessment in EMR ▪ Formulating a more precise and feasible skin assessment protocol for Muhlenberg Emergency Department ▪ Communication tool to the Inpatient Units  Implementation ▪ Employee in-service ▪ Skin Champion recognition ▪ Pre-Intervention Survey  ▪ Skin Assessment hand off sheet  Pre-Intervention Assessment  Questionnaire for Skin Assessment Communication from the ED to the Admitting Unit   Are you aware that a skin assessment was completed on your patient admitted via the ED?         ⃝ Always    ⃝ Sometimes  ⃝ Never  Are you aware that a skin patient safety report was submitted if necessary on your patient admitted via the ED?       ⃝ Always  ⃝ Sometimes  ⃝ Never Are you aware if protective skin barrier products have been utilized on your patient admitted via the ED?        ⃝ Always  ⃝ Sometimes  ⃝ Never  Results/Outcome 0 0 0 13 7 2 15 8 13 Respondents aware skin assessment completed by ED Respondents aware Patient Safety Report completedby EDRespondents aware protective skin barrier productutilizedPre-Survey Results:   Skin Assessment Hand-Off Communication Form Always Sometimes Never0 5 10 15 20YesNoRespondents in favor of a skin assessment hand-off communication form Respondents in favor of askin assessment hand-offcommunication formResults/Outcomes 0.91% 0.95% October 2013 - June 2014 October 2014 - June 2015384 Total Patient Safety Reports 402 Total Patient Safety Reports42,091 Total ED Visits 42,116 Total ED VisitsPercentage of Patient Safety Reports Percentage of Patient Safety ReportsResults/Outcomes ▪ Missed Pressure Ulcers on Admission from Emergency Department Muhlenberg:  •April – ZERO •May – ZERO •June - ZERO Change in Practice ▪ Prompt skin assessment and reassessment ▪ Effective communication tool to inpatient unit ▪ Reposition every two hours and/or as needed ▪ Protective skin barrier products   References ▪ Bergquist-Berringer et al. Pressure ulcers and prevention among  acute care hospitals in the United States. Jt Comm j Qual  Patient Safety. 2013; 39(9); 404-414 ▪ Denby A, Rowlands A. Stop them at the door. Should a pressure  ulcer prevention protocol be implemented in the emergency  department? J Wound, Ostomy, Continence Nurs.  2010;37(1):35-38. ▪ Rogers, C et al. Improving process to capture on admission pressure  ulcers. Advances in Skin and Wound Care. 2013;26(12):566- 572 Questions or Comments? Make It Happen ▪ Lets Save Some Skin! 

Taking the Pressure Off in the Emergency Department

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1500&context=patient-care-services-nursing

Taking the Pressure Off in the Emergency Department

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