Getting Started With a PICOT Question
Physical injuries to any part of the body cause significant pain and discomfort to the patient. Such traumas often require drastic lifestyle changes to ensure the injured individuals recover quickly and do not sustain additional damage. However, these changes, specifically prolonged bed rest, can result in the development of pressure ulcers that are detrimental to the patients’ health and well-being. This assignment will examine an intervention addressing the pressure injury protocol implementation starting in the emergency department.
Pressure injuries present a severe medical issue and are detrimental to the health and well-being of the patients. Such injuries can also be referred to as ulcers or sores and occur “when direct pressure causes tissue ischemia in the skin, muscle, and fascia” (Powers & Ames, 2018, p. 4). Thus, pressure ulcers are the result of compression and friction, preventing blood flow and oxygen delivery in the capillaries and leading to edema, tissue ischemia, and tissue death (Powers & Ames, 2018). The severity of pressure sores depends on the duration of time patients spend in the position that causes the compression of small blood vessels. According to Santamaria et al. (2019, p. 747), pressure injuries are typical for areas on the body with bony prominences, including heels, coccyx, and sacrum that can “distort the inferior soft tissues.” Although pressure sores are likely to emerge after a prolonged stay in a hospital, they can occur quickly if high pressure is applied. Thus, it is essential for nurses to check patients for pressure injuries in emergency departments to avoid blood vessel compression and sore formation.
Pressure injuries are common for patients admitted to emergency wards that spent extended periods of time waiting for admission and are restricted in movement. Fulbrook et al. (2019) note that the prevalence of pressure ulcers varies from 3.1% to 18% worldwide for patients in acute settings. The sores can be extremely painful and lead to infection, exacerbating the condition of the patient. Therefore, it is crucial to ensure individuals admitted to the emergency ward do not develop wounds during their stay. The proposed research aims to identify whether implementing a pressure injury protocol initiated in the emergency department can reduce the incidence of hospital-acquired pressure sores in patients compared to those who receive usual care. The intervention includes full-body skin assessments, providing support surfaces for patients, their regular repositioning, and the use of shear-decreasing surfaces and devices. It is expected that the intervention will alleviate the pressure and help prevent ulcers in patients admitted to emergency departments on day 3 of hospitalization.
Barriers to Implementation
There are several barriers to the implementation of the proposed pressure ulcer intervention in the emergency departments. The first barrier is organizational and concerned lack of wound nurses working in the emergency wards. According to Teo et al. (2018), wound nurses have extensive knowledge of different types of injuries and are often referred to by practitioners unfamiliar with the treatment of extensive pressure ulcers. The second barrier is the workload and the limited amount of time nurses can dedicate to a patient. Pressure injury prevention includes repositioning the patient to decrease the blood vessel compression every two hours, and nurses do not always have the time to dedicate to it due to the number of patients they tend to. Overall, the primary barriers to pressure injury protocol implementation include the substantial workload and lack of wound care nurses in emergency departments.
Addressing the Barriers
The barriers to pressure ulcer protocol in emergency departments can be addressed through a training program and patient assessment protocols. Thus, wound nurses can lead a training session before the pressure injury protocol is initiated to ensure all nursing practitioners are familiar with ulcer treatment and prevention. The training will lead to more nurses being aware of what types of patients can develop pressure sores and how to treat early-stage injuries and limit their progression. The workload and time constrain in emergency departments can be addressed by assigning more nurses to the ward. In addition, patient assessment for the risk of developing ulcers can be performed. For example, persons at high risk of pressure injuries can be repositioned every two hours by the nurses, while other patients can be repositioned or reassessed for sores at longer intervals. Furthermore, it is vital to ensure communication between the nurses to eliminate replicate repositioning and assessments. Thus, the discussed barriers to implementing pressure injury protocol in emergency departments can be addressed to ensure the well-being of the patients.
Analysis of the evidence will help establish whether the protocol initiation in the emergency department can reduce pressure injuries in patients on day three of hospitalization. The primary criteria to be used in the assessment are patients with or without hospital-acquired pressure ulcers measured on day three of hospital stay and admitted via the emergency department. Patients who received pressure injury prevention care and regular care will be included in the analysis. However, individuals with motor impairments and disabilities will be excluded from the analysis as the preexistent mobility issues can affect the evidence analysis. Older persons are to be omitted from the analysis as they may not be physically active and more susceptible to the formation of sores.
Literature Search: Databases and Keywords Used
Several databases were employed in the initial search on literature pertaining to pressure ulcers and their treatment in the emergency department. Wiley Online Library, Science Direct, and PubMed online databases were searched for relevant studies and research articles. In addition, Google Scholar was utilized to search for additional papers as it allows access to a wide variety of works from different academic sources. The keywords applied in the search included “pressure ulcer,” “pressure ulcer protocol,” “pressure ulcer intervention,” and “pressure injury.” It should be noted that the last keyword aided the search substantially as the majority of the articles in the yielded results favor the term “pressure injury” over “pressure ulcer.” Thus, the keywords were extended to “pressure injury intervention” and “emergency room” to limit the scope of the search results. Overall, several pertinent studies were discovered and helped inform the present research.
Hospital-acquired pressure injuries are highly detrimental to the health and well-being of patients as they can lead to infection and exacerbate the initial trauma that led to the initial admission. The proposed research aims to determine whether a protocol initiated in the emergency department effectively reduces the occurrence of hospital-acquired pressure ulcers in patients compared to those who receive usual care. The intervention will include full-body skin assessment, patient repositioning, and support surfaces for persons at high risk of sore development. The expected finding is a substantial reduction in pressure injury incidence among patients admitted via the emergency department.
Fulbrook, P., Miles, S., & Coyer, F. (2019). Prevalence of pressure injury in adults presenting to the emergency department by ambulance. Australian Critical Care, 32(6), 509-514. Web.
Powers, J., & Ames, C. (2018). Take action to solve causes of pressure injuries. American Nurse Today, 13(5), 4–6.
Santamaria, N., Creehan, S., Fletcher, J., Alves, P., & Gefen, A. (2019). Preventing pressure injuries in the emergency department: Current evidence and practice considerations. International Wound Journal, 16(3), 746–752. Web.
Teo, C. S., Claire, C. A., Lopez, V., & Shorey, S. (2018). Pressure injury prevention and management practices among nurses: A realist case study. International Wound Journal, 16(1), 153–163. Web.