Changing the Paradigm of Nursing in the Emergency Department

Pressure ulcers are a universally recognized indicator for the quality of nursing care. In 2008, the Center for Medicare and Medicaid Services established new guidelines which significantly changed the acute care approach to one of prevention. This change made clear the expectations and consequences which could occur if preventive measures and education were not carried out.  The new guidelines addressed the in-patient setting, however, did not include clear expectations for emergency room care.  Many articles have been written on prevention guidelines, yet little has been researched regarding the emergency department (ED), which for many patients is the point of entry into the acute care environment.

A community hospital, part of a 1200+ bed hospital system, recognized this as an opportunity to develop a guideline for practice.  These guidelines would set clear expectations for care at the point of entry into an acute care environment.  As an integral part of the hospital wide dermal defense team, an emergency department staff nurse engaged the department in becoming aware of integumentary system issues, and on prevention efforts that can begin upon admission to that department.  These prevention efforts included the use of a pressure redistribution mattress, education for the ED staff, and an increased awareness of pressure ulcer risk factors. Through these efforts, the hospital has witnessed a decrease in pressure ulcer development. The ED staff have developed a practice which directly impacts patients from their point of entry forward; a true evolution in the practice of a continuum of care.