Revalidation of the Perioperative Risk Assessment Measure for Skin (PRAMS)

Background: Validated perioperative pressure injury (PI) risk assessment measures are few and often cumbersome to complete, leading to missed opportunities in identifying and targeting prevention interventions to those patients at increased risk for developing a post-surgical PI. Previous validation of a six risk indicator perioperative risk assessment measure for skin (PRAMS) was conducted in our 500-bed community hospital with positive findings.

Purpose: The purpose of this study was to increase generalizability by revalidating the PRAMS in a larger population.

Methods: Retrospective application of the PRAMS to adult surgical inpatients ≥18 years, positioned in the supine or lateral position in a 1500 bed Midwest quaternary care multispecialty hospital during a six month period (n-1526) served to validate the measure. The main outcome of interest was the development of PI after surgery. Risk indicators of interest included diabetes, age, surgical time, Braden score, prior surgery, and pre-existing PI, data points readily available to staff. The diagnostic ability of the effect of any risk indicator on the development of a post-surgical PI was evaluated using sensitivity, specificity, and predictive values.

Results: A total of 121 patients with post-surgical PIs were identified. The PRAMS was effective in identifying surgical patients at risk for PI (Sensitivity 0.98). Patients with a post-surgical PI had a lower mean Braden score (p<0.001), were more likely to have a pre-existing PI (p<0.001), and had undergone previous surgery during the same admission (p<0.001), comparing favorably to the original study. Patients with no risk indicator were unlikely to develop a post-surgical PI (NPV 0.98).

Discussion: Results of both validation studies support the PRAMS as effective in identifying patients who develop a post-surgical PI. As part of a comprehensive, nurse-initiated perioperative pressure injury prevention protocol, the PRAMS may serve to guide the initiation of prevention interventions to at-risk patients.