A Change in Skin Risk Assessment: SIRAP

Topic:  Skin Integrity Risk Assessment and Prevention (SIRAP) is an easy to use and understandable tool suitable for all ages. SIRAP uses a dichotomous variable of ‘at risk’ or ‘not at risk’ for 6 assessment categories (including devices) with weight and gestational age (if applicable) also considered.  The uniqueness of this tool is its provision for nursing decision support to guide evidenced based pressure ulcer interventions. These interventions are driven by documentation, and are tied to specific risks rather than to an overall score.  Previously published risk assessment scales have not included a category for devices, although they have been identified as a leading risk of skin injury in all patient populations. 

Purpose:  To establish the reliability and validity of SIRAP for skin integrity risk identification among patients from birth (including preterm) through 17 years of age.

Methodology:  This single-site study utilized a convenience sample of 300 subjects aged birth (including preterm infants) to 17 years of age to evaluate the measurement properties of SIRAP. Concurrent validity was assessed with tools having previously established reliability and validity. For subjects under 30 days of age the comparison tool was the Neonatal Skin Risk Assessment Scale (NSRAS), and for subjects 31 days through 17 years the Braden Q.

Statistics:  Interrater reliability was examined using Intraclass Correlation Coefficients. Concurrent validity procedures compared SIRAP with the NSRAS and the Braden Q using Pearson Correlation Coefficients.

Results:  The interrater reliability for SIRAP was very high (0.876). SIRAP strongly correlated with both the NSRAS (0.725) and with the Braden Q (-0.634).

Conclusion:  SIRAP is valid and reliable across the studied age groups and accounts for device-related pressure.  SIRAP guides pressure ulcer prevention interventions to specific skin integrity risks.