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Background:
Pressure ulcer prevalence and incidence continues to be a problem in the acute care setting, raising the question of whether all pressure ulcers are avoidable. The purpose of this study was to develop a definition and tool to identify avoidable/unavoidable hospital-acquired pressure ulcers (HAPU). After a thorough review of the literature an evidence-based definition for avoidable/unavoidable HAPU was developed and the Indiana University Health Pressure Ulcer Inventory Tool (PUI) was created.
Methods:
Following content and construct validity testing, a retrospective pilot study using a sample of 29 adult hospitalized patients with a HAPU was conducted. PUI content validity was examined using content validity indices (CVI). Criterion validity, construct validity, and inter-rater reliability were examined using descriptive analyses, analysis of variance, chi-square tests, and correlation tests.
Results:
Total CVI of 0.99 and individual item CVI scores (0.9-1.0) demonstrated excellent content validity. There were no statistically significant differences comparing Wound Specialists (four WOC and one CWS) and other experts (one MD, two direct care nurses, one nurse researcher PhD, one nurse administrator PhD) scoring on all items, demonstrating acceptable PUI convergent and divergent validity. Construct validity was also demonstrated with no statistically significant differences among patients with a HAPU and the Braden conceptual model concepts (sensory perception, activity, mobility, moisture, nutrition, or friction/shear subscale scores or total Braden scores). Expert panel comments and suggestions were reviewed and appropriate PUI revisions were made. Five subjects were evaluated by two raters with perfect agreement on total PUI score (Kappa=1.0, p=0.025). Raters were in total agreement 93% (242/260) of the time on all 12 individual PUI items.
Conclusion/Implication:
Using the evidence-based definition for identifying avoidable and unavoidable pressure ulcers in the acute care setting, an important and useful instrument was developed, providing an objective method of measurement for identifying a HAPU as avoidable or unavoidable.