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Design: IRB-approved prospective observational study performed at a large Magnet-designated, academic medical center, and level 1 trauma center in the southeast United States.
Method: The Norton Pressure Sore Risk Assessment Scale (Norton Scale) was optimized for use in the critical care setting. A convenience sample of 114 clinicians (n=111 critical care nurses and n=3 certified WOC nurses) assessed the pressure injury risk of a video simulated critical care patient using the optimized Norton Scale (oNS). Data were collected on validity, reliability, usability, and preference.
Results: All 114 participants were able to accurately predict the patient’s high risk for pressure injury using the oNS. Predictive validity of the oNS was excellent based on a correlation coefficient > 0.6. The oNS demonstrated excellent reliability based on Cronbach’s α of .944. Intraclass correlation coefficient (ICC) demonstrated a high degree of interrater reliability for the five oNS subscales. The average measure ICC was .933 with a 95% confidence interval from .911 to .950 (F(113,456)= 14.841, p<.001). 71.2 to 84.9 percent of the participants agreed that the oNS represented desired characteristics of a critical-care specific risk assessment tool. Preference for the oNS were associated with the perception that it was easier, quicker, and more critical-care specific than the incumbent Braden Scale.
Conclusions: Implementation of the oNS fills a gap in practice. It provides critical care nurses a quick and easy to use risk assessment tool that focuses on the unique vulnerabilities of patients with critical illness. This focused risk assessment facilitates effective and efficient initiation of risk-focused pressure injury prevention strategies.