Initiating a Skin-Care Bundle in the Emergency Department to Decrease Hospital-Acquired Pressure Injuries in Geriatric Patients

BACKGROUND: Adults 65+ comprise 15.2% of the United States (U.S.) population and 17.9% of Emergency Department (ED) visits. Aging causes changes to skin, including thinning and loss of elasticity. Annually, in the U.S., 2.5 million individuals develop Pressure Injuries (PI), causing 60,000 deaths. Hospital acquired PIs in the U.S. cost $26.8 billion annually, over $10,000/patient and increase the length of stay by greater than four days.

LOCAL PROBLEM: This project occurred in a 27-bed Geriatric Accredited Emergency Department in a southeastern U.S. city where patients 65+ comprise 40% of the patient volume annually. PIs can begin developing within two hours. The average length of stay in this ED was above the national average of 187 minutes. The project’s purpose was to improve skin care assessments/care for ED patients 65 +. The specific aim was to implement an ED evidence-based (EB) skin care bundle and a 10% increase in charting compliance for these specific patients.

METHODS: The Evidence-Based Practice Improvement model was used to implement this project. The literature review strongly recommended using pre-tests and post-tests with traditional classroom learning utilizing PowerPoint to increase knowledge of PI prevention and documentation adherence.

INTERVENTIONS: 51 ED nurses completed a pre-test, were educated about evidence-based care to prevent PIs/EB pressure bundle using classroom learning with PowerPoint presentation, and then completed a post-test to assess knowledge levels.

RESULTS: The mean number of incorrect answers significantly decreased from 10.8 to 5.06. There was a statistically significant decrease in wrong answers from the pre-test to the post-test, t (50) = 11.692, p=

CONCLUSIONS: The specific aim to implement a skin care bundle was met and the ED nurses significantly increased their PI knowledge. Due to issues with charting compliance reports, charting compliance with bundle was not measured.