Development of the interRAI Pressure Ulcer Risk Scale (PURS) for use in long-term care and home care settings

Abstract

BackgroundIn long-term care (LTC) homes in the province of Ontario, implementation of the Minimum Data Set (MDS) assessment and The Braden Scale for predicting pressure ulcer risk were occurring simultaneously. The purpose of this study was, using available data sources, to develop a bedside MDS-based scale to identify individuals under care at various levels of risk for developing pressure ulcers in order to facilitate targeting risk factors for prevention.MethodsData for developing the interRAI Pressure Ulcer Risk Scale (interRAI PURS) were available from 2 Ontario sources: three LTC homes with 257 residents assessed during the same time frame with the MDS and Braden Scale for Predicting Pressure Sore Risk, and eighty-nine Ontario LTC homes with 12,896 residents with baseline/reassessment MDS data (median time 91 days), between 2005-2007. All assessments were done by trained clinical staff, and baseline assessments were restricted to those with no recorded pressure ulcer. MDS baseline/reassessment samples used in further testing included 13,062 patients of Ontario Complex Continuing Care Hospitals (CCC) and 73,183 Ontario long-stay home care (HC) clients.ResultsA data-informed Braden Scale cross-walk scale using MDS items was devised from the 3-facility dataset, and tested in the larger longitudinal LTC homes data for its association with a future new pressure ulcer, giving a c-statistic of 0.676. Informed by this, LTC homes data along with evidence from the clinical literature was used to create an alternate-form 7-item additive scale, the interRAI PURS, with good distributional characteristics and c-statistic of 0.708. Testing of the scale in CCC and HC longitudinal data showed strong association with development of a new pressure ulcer.ConclusionsinterRAI PURS differentiates risk of developing pressure ulcers among facility-based residents and home care recipients. As an output from an MDS assessment, it eliminates duplicated effort required for separate pressure ulcer risk scoring. Moreover, it can be done manually at the bedside during critical early days in an admission when the full MDS has yet to be completed. It can be calculated with established MDS instruments as well as with the newer interRAI suite instruments designed to follow persons across various care settings (interRAI Long-Term Care Facilities, interRAI Home Care, interRAI Palliative Care).

Is Braden Scale Reliable and Sufficient to Evaluate the Risk of Pressure Ulcer Occurrence in Level 3 Intensive Care Unit Patients?

“…The BRDs cover only part of these risk factors and is thus considered to be inadequate in the full risk assessment. Risk assessment scales that contain the other parameters and that are more suitable for the patients of our country are required, or the existing scales need serious modifications (29,31,(44)(45)(46)(47)(48)(49). Pressure ulcer development risk in patients treated in ICUs should be revised in coordination with healthcare workers.…”

Cuidados de enfermagem na prevenção de úlcera por pressão em pacientes acamados no domicílio

“…Dados das condições clínicas: sinais vitais, estado nutricional, mobilidade, perfusão tecidual, hidratação e condições da pele. E dados de fatores propícios ao surgimento das úlceras de pressão, como: tabagismo atual, tabagismo pregresso, tempo de acamado, doença de base, alcoolismo e outras doenças associadas (POSS et al, 2010).…”

“…Os principais fatores de risco descritos na literatura são a mobilidade prejudicada, desnutrição e baixo índice de massa corporal (IMC), problemas de saúde física, incluindo os que afetam a oxigenação e perfusão, idade avançada, temperatura corporal, fricção e cisalhamento, umidade da pele, dificuldades cognitivas e de percepção sensorial (ARAÚJO; MOREIRA; CAETANO, 2011;POSS et al, 2010).…”

The Use of a No-sting Barrier Film Treatment Protocol Compared to Routine Clinical Care for the Treatment of Stage 1 and 2 Pressure Injuries in Long-term Care

“…These factors increase the chance of skin breakdown and complicate treatment. [2][3][4] Furthermore, because LTC residents have multiple chronic diseases and may have increased medication burden, 5,6 wounds that may been healable in younger populations are deemed as maintenance or unhealable wounds. 7 Vital to supporting wound healing, current best practice guidelines for treating pressure injuries recommend off-loading pressure, reducing friction and sheer forces, appropriate debridement, proper nutrition, infection Funding Source: This study was not funded by any research grants or funding agencies.…”