Development of a Pressure Ulcer Prevention Program in the Emergency Department (PUPPED)

It is time to ‘leave no stone unturned’ in PUP programs.  Patients need to be identified as ‘at risk’ and protected from hospital acquired conditions (HACs) from the time they enter the hospital, until the time they leave.  While the average “Door to Doc” times are becoming measured in minutes, the average boarding time remains high - anywhere from 2 hours to 12 hours or more.

PUPPED is an evidence based program, created with the goal of protecting patients from admission to discharge.  In order to accomplish this, 'at risk' patients need to be identified througout the hospital, and preventative measures need to be implemented before the patient reaches the nursing units. 

Risk assessment and intervention forms were created and accompanied by extensive education.  The ED staff were taught to identify and photograph pressure ulcers, document present on admission, and follow care pathways which include preventative dressings, skin barriers and surfaces.  ‘At risk’ patients have also been identified with a light blue arm band which includes the letters P. U. P..  The ‘at risk’ patients wear the bracelet until they are discharged.                           This poster will include the aspects of assessment, documentation, and intervention as well as barriers to implementation. 

The creation and implementation of this program is considered a success in itself.  Ongoing evaluation and education will be necessary to ensure continued compliance.  Additional outcomes of this new program will be evaluated during spot checks and during prevalence audits. This program is considered dynamic and will be adapted as needed to ensure optimal outcomes and patient protection.

Optimally, this poster will ignite a common practice of identifying ‘at risk’ patients with a light blue armband.  Patients could then be recognized post hospital stay – in rehabilitation, the skilled nursing facility, or by home health, as ‘at risk’.