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Pediatric pressure injuries: does modifying a tool alter the risk assessment outcome?
Paul Leonard1, Astrid Hill, Kylie Moon
1Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne , Victoria , Australia .
Insights
The modified Glamorgan Scale (mGS) effectively identifies pressure injury risk in neonatal and pediatric intensive care units, showing minimal differences compared to the original Glamorgan Scale (GS). The mGS also proved easier to use, offering similar risk assessments for pediatric patients.
Area of Science:
- Pediatric Intensive Care
- Neonatal Nursing
- Patient Safety
Background:
- Pressure injuries pose a significant risk to vulnerable patients in intensive care settings.
- Accurate risk assessment tools are crucial for timely intervention and prevention strategies.
- Existing tools may require adaptation for specific pediatric and neonatal populations.
Purpose of the Study:
- To evaluate the modified Glamorgan Scale (mGS) for pressure injury risk assessment in Pediatric Intensive Care Units (PICU) and Neonatal Units (NNU).
- To compare the risk identification capabilities of the mGS against the standard Glamorgan Scale (GS).
- To assess the usability and effectiveness of the mGS in clinical practice.
Main Methods:
- Prospective data collection over a 2-month period.
- Assessment of 112 patients using both the mGS and GS.
- Risk scores determined through patient observation, record review, and nurse consultation.
- Chi-square analysis to compare risk category allocations between the two scales.
Main Results:
- Both the mGS and GS allocated most patients to 'High Risk' or 'Very High Risk' categories.
- There was minimal difference in risk category allocation between the mGS and GS (p=0.982).
- Only one patient was assigned a different risk category by the two tools; the mGS was found to be easier to complete.
Conclusions:
- The modified Glamorgan Scale (mGS) demonstrates comparable pressure injury risk identification to the Glamorgan Scale (GS) in PICU and NNU settings.
- The mGS is a viable and user-friendly alternative for assessing pressure injury risk in these critical care environments.
- Further research is needed to confirm agreement in the general pediatric population and understand the impact of modifications on outcomes.
Abstract:
The aim of this study was to determine whether assessing patient risk of developing pressure injuries in Pediatric Intensive Care (PICU) and Neonatal Units (NNU) using a modification of the Glamorgan Scale (mGS) would alter the risk identification when compared to the Glamorgan Scale (GS). Prospective data were collected from a convenience sample of patients admitted to PICU or NNU during a 2-month period. The patients' pressure injury risk score using both instruments was collected by observing patients, reviewing patient records, and clarifying information with bedside nurses. Chi square analysis was used to compare the risk category allocations. A total of 133 patients were assessed with complete data available for 112 (PICU = 68, NNU = 65). The total number of admissions during the data collection period was 202 in PICU and 100 in NNU. There was an extensive spread of patients allocated to the "High Risk" and "Very High Risk" categories in both units. Only one was in the lower "At Risk" category. There was little difference in allocated risk category between the mGS and the GS (p = 0.982). Only one patient was not allocated to the same risk category by both tools. In addition to identifying little difference in risk identification the mGS was found to be easier to complete. The mGS delivered the same risk rating as the GS when applied to patients in the PICU and NNU. It is not clear if a similar agreement exists in the general pediatric population. When modifying a validated tool for local use consideration should be given as to how those modifications might alter outcomes.
