Background: In October 2008, the Centers for Medicare and Medicaid Services (CMS) discontinued reimbursement for certain hospital-acquired conditions (HACs) which includes stage III/IV pressure ulcers (PUs). According to the CMS, stage III/IV PUs are considered hospital acquired if not documented as present on admission (POA). CMS defines POA as present at the time the order for inpatient admission occurs, conditions that develop during an outpatient encounter, including the ED, observation, or outpatient surgery. Patients referred to this facility are mostly frail elders with multiple comorbidities and limited mobility putting them at high-risk for developing new PUs, specifically suspected deep tissue injuries (SDTIs). The purpose of this QI project was to evaluate pressure ulcer prevention (PUP) interventions applicable to the ED. ED nursing staff was educated on PUP and identification using a pocket guide. The goal was to prevent hospital-acquired SDTIs in non-ambulatory patients with pre-existing full-thickness PUs held in the ED for 4 hours longer. EBP Change Model: Larrabee’s Model for Evidence-Based Practice Change was used to guide this project and Kotter’s concept of the guiding coalition from his process on leading change. Methods: Data was collected utilizing real-time chart review on all non-ambulatory patients with pre-existing full-thickness PUs identified by the ED nurses as POA. A daily log was maintained by the wound specialists on the number of patients admitted and whether PUs observed on patient assessment were POA or hospital acquired in the ED. Outcomes: There were no hospital-acquired SDTIs PUs among patients with pre-existing full-thickness PUs held in the ED for 4 hours or longer. PU prevalence was 3%, incidence 0%. No chronic wounds were incorrectly identified as PUs. Implications for Nursing: Evidence-based PUP interventions can and should be implemented in the ED. Focused PUP education can improve the ED nurse’s ability to correctly identify pressure ulcers from other chronic wounds and implement prevention techniques using a standardized pocket guide. ED nurses can be engaged to participate in PUP with access to expert resources and education.
