Instrument Validation Study: IAD-SI Interrater Reliability in Clinical Setting

Moisture Associated Skin Damage (MASD) is an inflammatory process affecting skin integrity (Gray et al 2011).  Patient outcomes are effected when clinicians misclassify MASD as pressure related injury. Borchert et al published development and validation study results Incontinence Associated Dermatitis and its Severity Instrument (IAD-SI), findings support face, content, criterion validity of IAD-SI (2010).  However, study design did not include evaluating IAD-SI in clinical setting (Borchert et al 2010).

Instrument development testing study.  IAD-SI tested intra-rater reliability and inter-rater reliability. Study design included 2 phases.  Phase-1, 77 critical care patients examined twice by CWOCN rater utilizing IAD-SI.  Purpose phase 1, determine validity, intra-rater reliability IAD-SI assessment tool.  Secondary purpose, identify patterns, trends relating independent and composite variables compared to patient’s IAD-SI scores.  Phase-2 purpose test inter-rater reliability IAD-SI, comparing CWOCN with clinician assessments completed simultaneous.  Target number non-CWOCN raters 12-20 in clinical nurses, CNS, and NP rated a combination of 63 critical care patients.  Recruitment targeted:  (1) completed SFH Skin Champion program 2011-1014 (2) CNS, NP or Nurse Educator.  The secondary purpose, identify patterns, trends relating independent and composite variables compared with patient’s IAD-SI scores.

IRB approved research questions: “What is the intra rater reliability of IAD-SI rating critical care patients by CWOCN?” and “What is the inter-rater reliability of IAD-SI rating critical care population comparing CWOCN Specialist with clinicians without wound care certification?”

Phase I: Intra-rater reliability, the Intra-class Correlation Coefficient (ICC) n the overall rating it was uniformly high across body areas testifying very high intra-rater reliability of IAD-SI.  Phase II:  Overall agreement between 20 nursing research assistants and CWOCN specialist was excellent. Individual ICC for the ratings paired with CWOCN specialist, mean ICC across these pairs was 0.96, standard deviation of 0.08, and median 0.995