Content Validation of an Emergency Department Skin Risk Assessment Instrument

Pressure injuries (PIs) are an important quality and patient safety metric for health care organizations. PI monitoring and treatment are often overlooked in the emergency department (ED). Emergency care professionals must be proactive about PI early identification and prevention strategies. A team at a Level 1 trauma center recognized the need for ED-friendly documentation and a validated ED skin risk assessment instrument. The Bjorklund 25-item ED Skin/Risk Assessment Tool was selected. However, because the tool was not fully validated, permission to validate/use was obtained from the author. The purpose of this research study was to determine the content validity of the Bjorklund Tool. Using a prospective survey design, content experts were recruited from wound, quality, and ED and participated in two rounds of content validation. The experts reviewed the Tool for relevance, clarity, and appropriateness for the ED population. Item-level content validity index (I-CVI) and scale-level CVI (S-CVI) were calculated, with 0.78 and 0.90 as the lower limits of acceptability for individual items and the overall scale, respectively. Of the first round I-CVI ratings, 24 of 75 were below 0.78, including 14 for relevance, four for clarity, and six for appropriateness. S-CVI was 0.7574 for relevance, 0.8809 for clarity, 0.8592 for appropriateness, and 0.8325 overall. The Bjorklund Tool was determined to be invalid in its current form. A novel tool was thus created in the second round per content experts' recommendations. After redesign and simplifying items and images, all I-CVIs rated above 0.78. S-CVI was 0.923 for relevance, 0.9743 for clarity, 0.9615 for appropriateness, and 0.9529 overall. These CVIs indicate excellent content validity of the new UCHealth ED Skin Risk Assessment Instrument. This research contributes to establishment of content validity of a skin risk assessment instrument which can be used in the unique ED setting.