Accurately Identifying At- Risk Patients to Prevent Pressure Ulcers

Pressure ulcers are a serious concern in acute care hospitals that can result in human suffering and costly resource utilization. With the new CMS “Present on Admission” guidelines, there is increased emphasis on early assessment and documentation of alterations in skin integrity in the Emergency Department (ED). This allows for pressure ulcer prevention (PUP) interventions to be initiated in a timely manner, ultimately resulting in improved patient outcomes and decreased nosocomial pressure ulcers.

 At Shands Jacksonville Medical Center, an abbreviated version of the Braden scale had been in use for identifying and quantifying pressure ulcer risk. However, we found there were staff inaccuracies in scoring the patient’s risk, which at times might delay identification of compromised patients or slow implementation of PUP.

 In the Fall of 2009, the Pressure Ulcer Risk assessment Tool (PURAT) was developed to improve the accuracy of identifying at-risk patients, increase the number of Wound Care Team consults originating in the ED, and decrease the nosocomial pressure ulcer rate.

 Baseline chart audits for risk assessment accuracy were completed one month prior to implementation of the PURAT.  Training of staff was completed and the PURAT was then placed in the ED patient chart for easy accessibility on adult patients with admission orders.  Post implementation chart audits as well as ongoing monthly prevalence studies have been performed.

 The accuracy of the Braden score improved.  Braden risk assessment scores that were inaccurate by 3 or more points decreased by 7%.    Wound Care Team consults from the ED increased threefold, and hospital wide  monthly nosocomial pressure ulcer prevalence rates excluding Stage I decreased from an average of 2.4% to 1.8% through September 2010.  Trending will continue through February 2011 (one year post implementation) for final documented outcomes.