Improving Pressure Ulcer Assessment Using the SLICK (Standard Language & Image Comparison Kard) Tool

The purpose of this project was to create a simple, point-of-care, picture tool, dubbed SLICK (standard language and image comparison kard), to aid nurses in basic pressure ulcer assessment.  Using the National Pressure Ulcer Advisory Panel (NPUAP) staging definitions, Phase I involved establishing the inclusion criteria and identifying images.  Regional wound care experts provided thousands of images from which to select.  Using a quota sampling design to include both Caucasian and African American skin tones, the researchers unanimously selected ten images representing each of the five NPUAP stages (Stage I, Stage II, Stage III, Stage IV, and Unstageable/Non-Observable) and five images illustrating three wound beds descriptions (fully-granulating, early/partial granulating, and not healing). (n=130)  In Phase II a panel of three nurses, certified wound care specialists or nurses with five or more years of clinical wound experience, were given the inclusion criteria and images.  The nurses were ask to identify and classify the images by stage or wound bed category for each skin tone, then rank the images (1=best to 5=worst). For each skin tone, inter-rater reliability scores were used to determine the top five images for the five stages and the top two images depicting the wound bed. (n=62)  In Phase III, five different wound care experts (including both physicians and nurses) repeated the process outlined in Phase II.  Again, using inter-rater reliability scores the top two rated images depicting the stages and the top-rated image depicting the wound beds were determined. (n= 26).  The final SLICK tool provides two images in each skin tone (Caucasian and African American) for each stage with several simple, text descriptors to aid in the assessment.   The wound bed component includes three images (fully-granulating, early/partial granulating, and not healing) for each skin tone with simple, text descriptors to aid in the assessment.