DISCOVER and R.E.A.C.T. involves a two-step, systematic approach to prevent and manage pressure injuries in the ED. Step 1 involves ‘DISCOVER’ which includes "skin inspection, that is head-to-toe, and using the grading tool, on you go!" Step 2 is initiated when a pressure injury is discovered. Step 2 follows the ‘R.E.A.C.T.’ mnemonic which involves Risk Man; Educate; Advocate; Care; and Turn.
DISCOVER and R.E.A.C.T.
The aim of this quality initiative is to improve patient care by raising awareness, educating, and reinforcing to nursing staff the significance of early detection and management of pressure injuries in the Emergency Department (ED).
Improved performance in compliance for skin inspections documented within the first eight hours of presentations; improved awareness of pressure injury prevention and appropriate dressing solutions in accordance with the type of injury and the stage of injury; improved delivery of comprehensive care to our patients in the emergency environment.
Redland Hospital ED staff identified a need to change the current process for addressing skin integrity in the Emergency Department. As a result of a pre-initiative questionnaire, it was revealed that there was a significant knowledge gap surrounding pressure injuries among nursing staff including how to grade pressure injuries against the staging tool, and how to determine which dressings are appropriate for the stage of pressure injury. From this result, the project evolved.
Implemented the DISCOVER and R.E.A.C.T model in the ED alongside a Pressure Injury Management (PIMs) trolley with reference guidelines for appropriate wound dressings, documentation of PIs in iEMR, RiskMan guideline, and pressure injury staging guidelines.
The initiative has been evaluated by colleagues during feedback sessions. Moreover the results were presented in 2018 at the Graduate Nursing Conference 'Insight' and in 2019 at an NMELT meeting to gain executive feedback and support. The results are constantly being monitored on the Comprehensive Care Dashboard and RiskMan Data. The team is currently in the process of collecting data from iEMR records to perform an audit report of our skin inspections pre- and post initiative.
There needs to be a shift in our culture surrounding skin inspections;
There is an educational gap in grading pressure injuries in the ED;
There is a knowledge gap in what dressings are appropriate for each stage;
Education for patients is also vital in preventing pressure injuries;
Staff were shocked at survey results during in-services; People are not always willing to adapt to change in the ED.
ED staff are overwhelmed by dressing options for pressure injuries and staff yearn for time-saving tools.
People are not always willing to adapt to change in the ED.
“R.E.A.C.T. to Red Skin” project NHS