Pressure Injury Assesment Comparison: Bedside Nurse vs. Experts

Background and Purpose: The National Pressure Ulcer Advisory Panel (NPUAP) defines a pressure injury (PI) as, “A localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear.” PIs affect millions of people each year creating a substantial financial burden. Medicare has created policies for reimbursement and reporting of PIs making it financially important for hospitals to correctly assess PIs upon admission. A basic skin assessment to categorize PIs has not been standardized among facilities, resulting in inaccuracies, poor documentation, and gaps in the reporting and quality of preventative care. Therefore, the purpose of this study was to compare the accuracy of standard bedside clinical PI assessment to expert assessment of the same patients using photographs and clinical history. Subjects: All patients with a PI at a 500 bed acute hospital on one day. Sixty-three patients were included with a range of 1-7 PIs on each patient. Methods: A point prevalence count of PIs was conducted by bedside nurses and documented. Four wound care experts also reviewed the wound documentation and photo documentation for these same patients to independently classify the skin injuries as PI or not and further to stage the PI. The bedside nurse data was then compared with the experts data. Results: Bedside nurses identified 105 PIs and experts identified 96 PIs. Kappa analysis was used to determine the amount of agreement between the two groups regarding the staging of PIs as well as classification of the PI as present on admission or hospital acquired. A 64% disagreement was found between the two groups for present on admission status (K=0.364, p\u3c0.000). A 54% disagreement was found between the two groups regarding staging of PIs (K= 0.460, p\u3e0.000)