Minimizing transportation injury

Topic: People with a spinal cord injury are at high risk for development of pressure ulcers (PrUs). Inpatients have developed deep tissue injuries(DTI) and/or worsening of preexisting wounds while out of our facility for doctor's appointments, emergency department visits, and radiological tests. Collaboration between the case manager, the primary nurse, the therapists, and the wound, ostomy, continence nurses is critical to determining the safest way to transport each individual patient, while advocating for their skin safety. Various skin interventions that have been implemented for patients during transport will be presented. Purpose: Traveling between facilities without proper safety precautions can result in a Hospital Acquired Pressure Ulcer (HAPU). Ambulance transportation is thought to be the safest way of patient transit. However, many variables during transport impact skin safety, including duration of supine lying on the stretcher, the head of stretcher position, the frequency and means of repositioning, and lack of lift assists in the facility. Often a suspected coccyx DTI is revealed days after transport, even though the patient received every possible means of PrU prevention during inpatient. Under the current trends of heightened insurance oversight, the development of HAPU increases hospital risk and prolongs hospitalization. Objective: Increasing patient and healthcare provider awareness of PrU risk in immobile and insensate patients during transport prevents transportation related PrUs and saves money and time. Outcomes: A multidisciplinary team approach discerned the safest transportation support surface for any particular patient. This decreased PrUs developing while patients were out of our facility for planned transports. Cost-effective pressure relief products and techniques are important elements for healthcare practice. Consideration should be given to providing a means of safe transport from the acute to the rehabilitation hospital at admission and developing a procedure for providing safe transportation out during an emergency.