Using moulage to simulate pressure ulcers-validation by wound care experts

Introduction

Our institution has initiated an online and didactic medical educational program focused on pressure ulcer (PU) prevention and treatment. Integral to this education is early PU detection and accurate staging. In order to assess the efficacy of this program we are studying whether PU detection and staging accuracy rates improve after educational intervention. Baseline PU detection and staging accuracy rates were determined.  As it is neither ethical, nor practical to use actual patients for this determination, standardized patients were moulaged with ulcers. In order to assess the realism of the moulage, this study was performed to validate the fidelity of moulaged PU to actual ones.

Methods

Standardized patients were moulaged to have pressure ulcers of varying stages. Using a high resolution camera, ulcers were photographed and images were sent electronically to wound care specialists internationally for review. Demographic data was collected on the reviewers. Using a Likert scale, reviewers were asked to determine the realism of simulated PU based on the images.

Results

Two hundred questionnaires were sent out electronically with a response rate of 51% (n=102). The mean wound care experience was 17.9 years, with wound care certification held by 80%. Respondents included 5 physicians, 85 nurses, 6 physical therapists and 6 classified as other. For PU one (suspected deep tissue injury) the mean realism rate was 81%. For PU two (unstageable) and ulcer three (Stage I) the mean realism scores were 90%.

Discussion

While early recognition of PU is well recognized as being critical to prevention and management, currently available methods of assessing competency, specifically use of photographs and recognition on real patients each present with unique and inherent  limitations. Moulage serving as a simulation device to mimic actual tissue damage may offer an effective alternative method to simulate PU.