Faculty Scholarly Dissemination Grants

Title

Protecting the Skin of Older Adults through Surveillance and Pressure Ulcer Prevention Beginning in Emergency Services

Department

Kirkhof College of Nursing

College

Kirkhof College of Nursing

Disciplines

Medicine and Health Sciences

Abstract

Nature and Scope of the Project: ED (emergency department) personnel are admitting to inpatient services increasing numbers of elderly clients who are at risk for skin breakdown. The ED environment is designed for short term care in response to emergent situations. Pressure related injuries originating in the ED lead to both physical suffering and financial burdens. Pressure relief strategies have been actively employed on an inpatient basis without translation to the ED environment. Evidence for best practice in PUP (pressure ulcer prevention) in the ED is not widely understood or embraced. Prevention of PUs is primarily within the scope of nursing practice and amenable to improvements in the standard of care. Therefore, the purpose of this project is to translate current evidence for PUP from the literature to sustainable best practice in emergency nursing. Synthesis and Analysis of Supporting and Related Literature: A synthesis of the existing literature revealed the most effective strategies for PUP focused on enhanced support surfaces, patient positioning, moisturizing dry skin, restricting HOB (head of bed) elevation, and timely removal of backboards. These measures reflect the most current evidence and are proposed as innovative strategies in the ED. A logic model will be utilized to guide planning and evaluation of the program. The theory of planned behavior and the consolidated framework for implementation research will be employed to ensure theory driven practice. Project Implementation: Following an organizational assessment and IRB approval, the project is being implemented at a 254 bed community hospital in the Midwestern United States with a 20 bed ED. A significant challenge to implementation is the culture of ED nursing which is focused upon stabilization and disposition versus prevention. The timeline for the project involves data collection, intervention, and evaluation over a four month period. Evaluation Criteria: A chart review will be conducted to established current documented practice of skin assessments and ED interventions directed at maintaining skin integrity. Nursing and support staff will participate in an educational intervention addressing the relationship between routine care and the unintended consequence of skin breakdown. Evidence for best practice in prevention will be reviewed and realistic measures for PUP presented for adoption. Learning will be evaluated in pre-test/post-test format. Nurses intention to implement best practice measures as well as perceived barriers/facilitators will be identified. The post intervention evaluation period will last two months and note utilization of skin moisturizes from ED supply. The terminal outcome will be a repeat chart audit of vulnerable elderly patients to evaluate for increased documentation of skin assessments and identified PU strategies. Outcomes and Recommendations TBD. This is an evidence-based project in progress.

Conference Name

2014 Annual Research Conference

Conference Location

St. Louis, MO

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