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Abstract: The annual cost of treating lower extremity ulcers in the United States is 3 billion dollars. In facility acquired heel ulcer rates vary from 7.5% to 15%, with treatment costs of between $3000.00 to $20,000.00 for each patient. Our goal is to develop an evidence-based risk assessment tool, specific to foot and lower extremity breakdown. A valid risk assessment tool would empower clinicians to more aggressively implement prevention programs and target patient education.
Method: Utilizing current standards of care and factors related to lower extremity skin breakdown, a targeted, specific assessment tool was developed. The tool was piloted for logistics; relevance in predicting risk for lower extremity skin breakdown; interrator reliability; and validity in multiple care settings.
Outcomes: Pilot studies, conducted in multiple care settings, afforded data collection to determine that the risk assessment tool is user-friendly for all levels of nurses and that the tool was relevant to multiple care settings. Data analysis of risk scores indicated that facilities were more likely to implement targeted preventative care approaches for their patients who scored within the high to very high risk category for lower extremity breakdown. Improvements in preventative care protocols were seen in 85% of the pilot facilities. Interrator reliability was determined through comparative scoring, using the risk assessment tool, between facility staff and the developers of the tool, reliability was >95%.
Conclusions: A valid risk assessment tool may assist clinicians to more aggressively implement lower extremity prevention programs. Further testing of the tool is needed for a broader statistical analysis of the reliability and validity of the tool. The need for further refinement of categories may become apparent with larger scale piloting of the tool.
Method: Utilizing current standards of care and factors related to lower extremity skin breakdown, a targeted, specific assessment tool was developed. The tool was piloted for logistics; relevance in predicting risk for lower extremity skin breakdown; interrator reliability; and validity in multiple care settings.
Outcomes: Pilot studies, conducted in multiple care settings, afforded data collection to determine that the risk assessment tool is user-friendly for all levels of nurses and that the tool was relevant to multiple care settings. Data analysis of risk scores indicated that facilities were more likely to implement targeted preventative care approaches for their patients who scored within the high to very high risk category for lower extremity breakdown. Improvements in preventative care protocols were seen in 85% of the pilot facilities. Interrator reliability was determined through comparative scoring, using the risk assessment tool, between facility staff and the developers of the tool, reliability was >95%.
Conclusions: A valid risk assessment tool may assist clinicians to more aggressively implement lower extremity prevention programs. Further testing of the tool is needed for a broader statistical analysis of the reliability and validity of the tool. The need for further refinement of categories may become apparent with larger scale piloting of the tool.