Pressure injuries are harmful, painful and potentially preventable.1 These injuries increase hospital length of stay and healthcare costs,2,3 and are associated with increased mortality.4 While pressure injury prevention is well-researched and practiced in the hospital setting, one area that has not been well investigated is prior to and on arrival to hospital. The objective of this study was to investigate the prevalence of pressure injury in adults on arrival by ambulance to the emergency department to determine areas where nursing assessment and preventative intervention may be improved.
Methods:
An observational, cross-sectional descriptive study design was used. Participants (n = 212) were recruited from the emergency departments of two Australian tertiary hospitals. Full skin inspection and pressure injury risk assessment, using Braden5 and Waterlow6 scores, were undertaken within one hour of presentation.
Results:
Pressure injuries were identified in 11 participants, giving a prevalence of 5.2% at ambulance presentation (11/212). Nearly two thirds of participants 60.4%, n = 128) were admitted to hospital and nearly all participants with an identified pressure injury (n = 10) were admitted to hospital, giving a prevalence of 7.8% (10/128) at the ward entry point. Participants with pressure injury and those at high risk of injury were found to have spent significantly longer in the ambulance and within the emergency department. During ambulance transport and in the first hour of presentation to the emergency department it was rare that pressure-relieving interventions were implemented, even for those with an identified pressure injury and those at high risk. In this study, the Waterlow score identified more patients at high-risk of pressure injury than the Braden Scale.
Conclusion:
The results indicate that early pressure injury surveillance and risk assessment is merited at the point of presentation to the emergency department so that prevention and treatment can be implemented at the earliest possible opportunity. Also, if pressure injuries are not identified at the hospital point of entry there is potential that such injuries may later be incorrectly classified as hospital-acquired, potentially incurring financial penalties. Whilst it may be considered challenging to manage pressure injuries within the ambulance and emergency department, preventative intervention should commence in the ambulance, while the patient is in transit, and should be continued in the emergency department with the use of pressure-relieving devices, particularly for those identified as being at high risk. At-risk patients who remain on non-pressure-relieving surfaces in the ED are at increased risk of PI development.