Development And Application Of Perioperative Pressure Ulcer Risk Assessment Scale

Object:1.To investigate the practice of pressure ulcer risk assessment among people undergoing operation and the use of pressure ulcer assessment scale.2.To identify the risk factors of surgical pressure ulcer on the basis of literature reading,experts interview and experts enquiry,and then develop a pressure ulcer risk assessment tool including preoperative,intraoperative and postoperative sub-scales,providing nursing staff with a reliable tool to dynamically assess risk levels of surgical patients.3.To compare the predictive validity of perioperative pressure ulcer risk assessment scale and Braden scale in predicting pressure ulcer among surgery patients,proving that perioperative pressure ulcer risk assessment scale is scientific and reliableMethod:1.Questionnaire: a self—designed questionnaire was used to investigate nurses from operation room and surgical ward in seven comprehensive hospitals in Jiang Su province to understand the implementation of surgical pressure ulcer risk assessment and the application of risk assessment scale.2.Delphi method: With Delphi method,thirty-nine experts from operation rooms,surgical wards and universities were consulted.After two grounds of consultation,a perioperative pressure ulcer risk assessment scale was formed.3.Clinical trial: Totally 175 surgical patients were assessed independently using perioperative pressure ulcer risk assessment scale and Braden scale by two trained assessors before,during operation and after surgery,the third qualified nurse observed and recorded the pressure ulcer incidence.After data analysis,the optimal cutting points were identified,the area under the ROC curve,sensitive,specific and positive predictive rate and negative predictive rate of two scales were compared to evaluate diagnostic value of perioperative pressure ulcer risk assessment scale.Result:1.OR nurses of seven hospitals used different kinds of scales for pressure ulcer risk assessment,the scale used were Braden scale,Waterlow scale and self—designed scale.The frequency and time for pressure ulcer risk assessment varied from one to three times,preoperative visit to handover in surgical ward;the Braden scale was used by surgical nurses to evaluate PU risk after operation,while most surgical nurses believed that the existing scale lacked specificity,and operative related risk factors that should be considered when assessing postoperative patients.2.Totally 25 risk factors were included and grouped into three dimensions.In the first round consultation,the response rate was 97.43%,coordination coefficients was 0.431,authority coefficient was0.828,the importance weight of factors range from 2.500±0.862 to 4.158±0.369;the response rate of second round consultation was 100%,coordination coefficients was 0.440,the importance weight of factors range from 3.105±0.311 to 4.236±0.430.Finally 9 risk factors were identified for perioperative assessment,6 for intraoperative and 2 for postoperative assessment.Then a perioperative pressure ulcer risk assessment scale was formed.3.The incidence of pressure ulcer after operation among 175 subjects was 10.3%,7 patients(4.0%)developed pressure ulcer in 24 hours after operation;The areas under ROC curves of perioperative pressure ulcer risk assessment scale before,during,and 24 hours after surgery were 0.846,0.835,and 0.830(P<0.05)respectively.The optimal cutting points of perioperative pressure ulcer risk assessment scale were 15(preoperative),17(intraoperative)and 20(postoperative),the predictive values were higher than those of Braden scale.Conclusion:1.At present,there is no standard guide for nurses to practice pressure ulcer risk assessment of surgical patients.The frequency and time of assessment are not standardized,the assessment procedure is discontinuous and non-dynamic,no specialized scale targeted on preoperative? intraoperative and postoperative pressure ulcer risk assessment can be applied.2.The Delphi method was used to identify the risk factories.After the consultations and modification,a perioperative pressure ulcer risk assessment scale was developed,including preoperative,intraoperative and postoperative sub-scales.The newly designed assessment tool is reliable and credible,it can help nurses assess the risk level of surgical patients comprehensively and take appropriate prevention,improving communication between nurses in surgical ward and in operation room.3.The risk assessment items of perioperative pressure ulcer risk assessment scale are more comprehensive,and the three sub-scales are more conducive to assess the pressure ulcer risk continuously.It has a higher diagnostic value compared with Braden scale.With the optimal cut-off scores,the sensitivity,specificity,positive predictive rate and negative predictive rate were higher than those of Braden scale.