- •New skin risk assessment scale developed for use across all age groups.
- •Easy to use and includes device-related pressure injury risk.
- •Includes clinical decision support for evidence-based pressure injury prevention interventions.
- •Demonstrates validity and reliability for risk assessment across all age groups.
- •Successfully implemented in an electronic health record at Midwest Children's Hospital.
To describe the development of a new skin risk assessment scale called Skin Injury Risk Assessment and Prevention (SIRA + P) and to establish initial reliability and validity of the scale among patients ranging in age from birth, including pre-term, to adulthood, regardless of age or acuity of illness.
The single-site study was a retrospective chart review to evaluate the measurement properties of SIRA + P. Charts of 385 patients of all ages and in all units (including the neonatal and pediatric intensive care units) of a free-standing children's hospital were included. Concurrent validity was assessed with scales having previously established reliability and validity. For subjects <30 days of age, the comparison scale was the Neonatal Skin Risk Assessment Scale (NSRAS); for subjects 31 days through 17 years, the Braden Q Scale (Braden Q) was used; and for subjects 18 years and older, the Braden Scale (Braden) was used. Interrater reliability was examined using Intraclass Correlation Coefficients (ICC). Concurrent validity procedures compared SIRA + P with NSRAS, Braden Q, and Braden using Pearson Correlation Coefficients.
Interrater reliability for SIRA + P was very high (0.878). SIRA + P strongly correlated with the NSRAS (0.725), the Braden Q (−0.634), and the Braden (−0.778).
SIRA + P is designed to be used within the EHR and includes nursing decision support to guide pressure injury prevention interventions for specific skin integrity risks. SIRA + P has good interrater reliability, is valid across all age groups and accounts for device-related pressure.
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- Pressure ulcers in neonates and children: An NPUAP white paper.Advances in Skin & Wound Care. 2007; 20: 208-220
- Prevention of tracheostomy-related pressure ulcers in children.Pediatrics. 2012; 129: e792-e797https://doi.org/10.1542/peds.2011-0649
- Eliminating serious, preventable, and costly medical errors—Never events.(Retrieved from)
- Prevention and treatment of pressure ulcers: Quick reference guide.National Pressure Ulcer Advisory Panel, Washington, DC2009
- Preventing hospital-acquired pressure ulcers: Improving quality of outcomes by placing emphasis on the Braden subscale scores.Journal of Wound, Ostomy, and Continence Nursing. 2012; 39: 292-294https://doi.org/10.1097/WON.0b013e3182514c3d
- Braden scale cumulative score versus subscale scores: Are we missing opportunities for pressure ulcer prevention?.Journal of Wound, Ostomy, and Continence Nursing. 2014; 41: 86-89https://doi.org/10.1097/01.WON.0000438017.83110.6c
- Predictive capacity of risk assessment scales and clinical judgment for pressure ulcers.Journal of Wound, Ostomy, and Continence Nursing. 2014; 41: 24-34https://doi.org/10.1097/01.WON.0000438014.90734.a2
- Predictive validity of the Braden scale for patients in intensive care units.American Journal of Critical Care. 2013; 22: 514-519https://doi.org/10.4037/ajcc2013991
- Pressure ulcer prevention and treatment protocol.Institute for Clinical Systems Improvement, Bloomington, MN2012
- Do pressure ulcer risk assessment scales improve clinical practice?.Journal of Multidisciplinary Healthcare. 2010; 3: 103-111
- Braden scale risk assessments and pressure ulcer prevention planning: What's the connection?.Journal of Wound, Ostomy, and Continence Nursing. 2009; 36: 622-634https://doi.org/10.1097/WON.0b013e3181bd812c
- Risk assessment tools for the prevention of pressure ulcers.The Cochrane Database of Systematic Reviews. 2014; 5CD006471https://doi.org/10.1002/14651858.CD006471.pub3
- Notes on nursing: What it is, and what it is not.D Appleton and Company, New York, NY1860
- Using the Braden Q scale to predict pressure ulcer risk in pediatric patients.Journal of Pediatric Nursing. 2011; 26: 566-575https://doi.org/10.1016/j.pedn.2010.07.006
- Risk assessment scales for pressure ulcer prevention: A systematic review.Journal of Advanced Nursing. 2006; 54: 94-110
- Risk assessment scales for pressure ulcers: A methodological review.International Journal of Nursing Studies. 2007; 44: 285-296
- Development of a pressure ulcer trigger tool for the neonatal population.Journal of Wound, Ostomy, and Continence Nursing. 2013; 40: 46-50https://doi.org/10.1097/WON.0b013e31826a4d99
- Guidelines for the prevention of pressure ulcers.Wound Repair and Regeneration. 2008; 16: 151-158https://doi.org/10.1111/j.1524-475X.2008.00356.x
- Diagnostic accuracy of two pressure ulcer risk scales and a generic nursing assessment tool: A psychometric comparison.Journal of Clinical Nursing. 2010; 19: 1510-1518https://doi.org/10.1111/j.1365-2702.2009.03005.x
- All at-risk patients are not created equal: Analysis of Braden pressure ulcer risk scores to identify specific risks.Journal of Wound, Ostomy, and Continence Nursing. 2012; 39: 282-291https://doi.org/10.1097/WON.0b013e3182435715
- Identifying the characteristics of children with pressure ulcers.Nursing Times. 2005; 101: 40-43
- The development of the Glamorgan paediatric pressure ulcer risk assessment scale.Journal of Wound Care. 2009; 18: 17-21
Published online: January 14, 2017
Accepted: December 31, 2016
Received in revised form: December 30, 2016
Received: October 10, 2016
© 2017 Elsevier Inc. All rights reserved.