Related Experiment Video
Updated: Mar 28, 2026
The Participant-Reported Implementation Update and Score PRIUS: A Novel Method for Capturing Implementation-Related Data Over Time
Published on: February 19, 2021
Unavoidable Pressure Ulcers: Development and Testing of the Indiana University Health Pressure Ulcer Prevention
Joyce Pittman1, Terrie Beeson, Colin Terry
1Joyce Pittman, PhD, RN, ANP-BC, FNP-BC, CWOCN, Wound/Ostomy Team, Indiana University Health-Methodist, Indianapolis, and Adjunct Assistant Professor, Indiana University School of Nursing, Indianapolis. Terrie Beeson, MSN, RN, CCRN, ACNS-BC, Indiana University Health Colin Terry, MS, Indiana University Health Jill Dillon, MSN, RN, CCRN, ACNS-BC, Indiana University Health Charity Hampton, BSN, RN, CCRN, Indiana University Health Denise Kerley, BSN, RN, CNRN, Indiana University Health Judith Mosier, BSN, MS, RN, CWOCN, Indiana University Health Ellen Gumiela, BSN, RN, Indiana University Health Jessica Tucker, BSN, RN, Indiana University Health.
Purpose:
Despite prevention strategies, hospital-acquired pressure ulcers (HAPUs) continue to occur in the acute care setting. The purpose of this study was to develop an operational definition of and an instrument for identifying avoidable/unavoidable HAPUs in the acute care setting.
Methods:
The Indiana University Health Pressure Ulcer Prevention Inventory (PUPI) was developed and psychometric testing was performed. A retrospective pilot study of 31 adult hospitalized patients with an HAPU was conducted using the PUPI.
Results:
Overall content validity index of 0.99 and individual item content validity index scores (0.9-1.0) demonstrated excellent content validity. Acceptable PUPI criterion validity was demonstrated with no statistically significant differences between wound specialists' and other panel experts' scoring. Construct validity findings were acceptable with no statistically significant differences among avoidable or unavoidable HAPU patients and their Braden Scale total scores. Interrater reliability was acceptable with perfect agreement on the total PUPI score between raters (κ = 1.0; P = .025). Raters were in total agreement 93% (242/260) of the time on all 12 individual PUPI items. No risk factors were found to be significantly associated with unavoidable HAPUs.
Conclusion:
An operational definition of and an instrument for identifying avoidable/unavoidable HAPUs in the acute care setting were developed and tested. The instrument provides an objective and structured method for identifying avoidable/unavoidable HAPUs. The PUPI provides an additional method that could be used in root-cause analyses and when reporting adverse pressure ulcer events.
