Purpose: To describe how point of entry clinical areas such as the emergency department and surgical services recognize and intervene for pressure ulcer prevention.

Objectives: Experts agree that a risk assessment should be performed upon entry into a healthcare setting (WOCN, 2003). Although the Norton and the Braden are two of the most common validated risk assessment scales, not all point of entry departments, such as the Emergency Department (ED), are well suited to using these scales. This abstract describes how recognition of risk for pressure ulcers differs in the ED and Surgical Services. It also describes how staff in these departments intervenes for pressure ulcer prevention.

The unit based educator for Outpatient Surgery (OPS) wanted to link interventions for pressure ulcer prevention to the Norton scale that nursing is required to complete upon admission. The ED does not complete a standardized risk assessment scale but wanted to intervene for pressure ulcer prevention. The Clinical Nurse Specialist was able to assist OPS and the ED with standardizing assessment and then intervening based upon the assessment.

Outcomes: OPS initiated tracking: completion of risk assessment on all patients, percentage of patients at-risk who received intervention, percentage of patients at risk for whom risk was communicated to the next site of care. The ED has elected to place a static air mattress on at-risk patients, specifically targeting end stage renal disease and hip fracture patients admitted to the hospital, two populations that typically spend greater than 2 hours in the ED. Risk is based on intrinsic and extrinsic factors and co-morbidities listed on a pocket card guide carried by staff. Beginning plans are in place to introduce the Norton to ED and to look at a support surface for ambulance gurneys.