Clinical Evaluation of a New Pressure Ulcer Risk Assessment Instrument, the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE T)

摘要

Aim: To test the psychometric properties and clinical usability of a new Pressure Ulcer Risk Assessment Instrument including inter-rater and test–retest reliability, convergent validity and data completeness. Background: Methodological and practical limitations associated with traditional Pressure Ulcer Risk Assessment Instruments, prompted a programme to work to develop a new instrument, as part of the National Institute for Health Research funded, Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056). Design: Observational field test. Method: For this clinical evaluation 230 patients were purposefully sampled across four broad levels of pressure ulcer risk with representation from 4 secondary care and 4 community NHS Trusts in England. Blinded and simultaneous paired (ward/community nurse and expert nurse) PURPOSE-T assessments were undertaken. Follow-up retest was undertaken by the expert nurse. Field notes of PURPOSE-T use were collected. Data were collected October 2012-Jan 2013. Results: The clinical evaluation demonstrated ‘very good’ (kappa) inter-rater and test–retest agreement for PURPOSE-T assessment decision overall. The percentage agreement for ‘problem/no problem’ was over 75% for the main risk factors. Convergent validity demonstrated moderate to high associations with other measures of similar constructs. Conclusion: The PURPOSE-T evaluation facilitated the initial validation and clinical usability of the instrument and demonstrated that PURPOSE-T is suitable of use in clinical practice. Further study is needed to evaluate the impact of using the instrument on care processes and outcomes.