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Content Validation of an Emergency Department Skin Risk Assessment Instrument.

Kathleen Flarity1, Wendy J Haylett, Melissa Childers

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Summary

Pressure injury risk assessment in emergency departments (EDs) needs improvement. A validated tool was developed after the original Bjorklund tool showed insufficient content validity for ED use.

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Area of Science:

  • Healthcare Quality Improvement
  • Patient Safety
  • Emergency Medicine

Background:

  • Pressure injuries (PIs) are critical quality and patient safety indicators.
  • PI monitoring and prevention are often neglected in emergency departments (EDs).
  • Emergency care professionals require effective, validated tools for PI risk assessment in the ED setting.

Purpose of the Study:

  • To determine the content validity of the Bjorklund 25-item ED Skin/Risk Assessment Tool.
  • To develop and validate a novel skin risk assessment instrument suitable for the unique ED environment.

Main Methods:

  • Prospective survey design involving two rounds of content validation by wound, quality, and ED experts.
  • Calculation of item-level content validity index (I-CVI) and scale-level CVI (S-CVI).
  • Iterative refinement of the assessment tool based on expert feedback and validity metrics.

Main Results:

  • The original Bjorklund Tool demonstrated insufficient content validity (overall S-CVI: 0.8325) in the initial validation round.
  • A redesigned, simplified tool incorporating expert recommendations achieved excellent content validity (overall S-CVI: 0.9529).
  • The new UCHealth ED Skin Risk Assessment Instrument showed high relevance, clarity, and appropriateness.

Conclusions:

  • The Bjorklund Tool, in its original form, was not suitable for ED use.
  • A novel, content-validated skin risk assessment instrument was successfully developed for the ED setting.
  • This validated instrument can enhance PI prevention and patient safety in emergency care.