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Published on: July 4, 2018
Development and validation of an ICU-specific pressure injury risk assessment scale
Ingrid Wåhlin1,2, Anna-Christina Ek3, Margareta Lindgren3
1Research Section, Region Kalmar County, Kalmar, Sweden.
Insights
A new tool, the Risk Assessment Pressure Ulcer Scale for Intensive Care Units (RAPS-ICU), effectively identifies critically ill patients at risk for pressure injuries. This validated scale enhances clinical practice by providing a reliable method for pressure injury prevention in ICUs.
Area of Science:
- Critical care medicine
- Nursing research
- Patient safety
Background:
- Critically ill patients face a high risk of pressure injuries (PI) due to their condition and medical interventions.
- Understanding PI risk factors and prevention methods is crucial in intensive care units (ICUs).
Purpose of the Study:
- To develop and validate a clinically useful ICU-specific PI risk assessment scale.
- The scale was based on the existing Risk Assessment Pressure Ulcer Scale (RAPS).
Main Methods:
- A prospective instrument development and validation study.
- Adapted RAPS items for ICU care, consulted ICU staff for relevance, and tested interrater reliability.
- Validated the instrument on 300 ICU patients with statistical evaluation.
Main Results:
- The final RAPS-ICU includes six items: vital organ failure, mobility, moisture, sensory perception, consciousness, and special treatments (mechanical ventilation, dialysis, inotropes).
- All items and the total score were significantly associated with PI development (p < 0.001).
- The RAPS-ICU demonstrated high interrater reliability (ICC = 0.96), good sensitivity, acceptable specificity (AUC = 0.71), and was perceived as relevant and easy to use by ICU staff.
Conclusions:
- The RAPS-ICU is a validated and clinically useful tool for identifying ICU patients at risk of developing pressure injuries.
- The scale aids in proactive pressure injury prevention strategies within the intensive care setting.
Background:
Critically ill patients are at high risk for pressure injury (PI) due to critical illness combined with multiple interventions and therapies. It is hence important to gain more knowledge about the risk factors associated with pressure injury development and methods for decreasing its prevalence.
Aims:
To develop and validate a clinical useful ICU-specific PI risk assessment scale based on the RAPS.
Method:
The study was designed as a prospective instrument development and validation study. The Risk Assessment Pressure Ulcer Scale (RAPS), which in Sweden is a commonly used PI risk assessment scale, was used as a starting point. Development was then performed in different steps; adaption of items and response options to ICU care, discussion with ICU staff members to enhance clinical relevance and usability, test of interrater reliability, revision of instrument, a new test with 300 patients followed by statistical evaluation.
Results:
The final version of the RAPS-ICU consists of six items: failure of vital organs, mobility, moisture, sensory perception, level of consciousness and special treatment in the form of mechanical ventilation, continuous dialysis and/or inotropic drugs. A total score was reached by summing all responses. Each of the items was found to be significant associated with PI development as well as the total score (p < 0.001). The total score also showed a high interrater reliability (ICC = 0.96), good sensitivity and acceptable specificity with AUC = 0.71 and ICU staff perceived the RAPS-ICU as relevant and easy to use in clinical practice.
Conclusion:
The RAPS-ICU is a valid and clinically useful tool to identify patients at risk to develop pressure injury at ICU.
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