Clinical evaluation of a new pressure ulcer risk assessment instrument, the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE T).
Susanne Coleman, Isabelle L Smith, Elizabeth McGinnis and 8 others
PMID 28833356WHAT IT FOUND
Nurses using PURPOSE-T agreed on whether adults were pressure-ulcer at risk in 93.4% of paired assessments, and scores stayed stable on repeat testing.
It also flagged existing ulcers through skin assessment, but outcomes were not tested.
Key findings
01For the simple at-risk or not-at-risk decision, expert nurses and ward/community nurses agreed in 93.4% of paired baseline assessments (kappa 0.81, PABAK 0.87, maximum kappa 0.94).
02On repeat testing, the risk decision agreed in 95.8% of pairs (kappa 0.87, PABAK 0.92, maximum kappa 0.99).
03PURPOSE-T and Waterlow placed all 60 patients with an existing pressure ulcer at baseline into an at-risk or secondary prevention category, whereas 25 of 145 patients called not at risk by Braden already had a pressure ulcer.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study tested agreement and validity of the assessment tool, not whether patients developed fewer pressure ulcers or received better care. Most participants were Caucasian, so skin assessment findings may not transfer to people with darker skin without further work. Expert nurses received focused training and direct access to the research team, so routine ward or community nurses may not achieve the same competence. Some patients and settings were excluded, including obstetric, paediatric, day case surgery and psychiatric populations, and patients too unwell to approach. Previous pressure ulcer history was often incomplete, and ward or community nurses were less likely than expert nurses to follow the recommended screening flow. Not all registered patients completed retest or were analysable; 217 were retested and 213 were analysed for test-retest.
Declared interests
The work was part of an NIHR-funded pressure ulcer research programme; the authors declared no conflict of interest.
The easy way to misread this
Do not conclude that PURPOSE-T prevents pressure ulcers or improves patient outcomes. This study tested how consistently nurses scored risk and how scores related to Braden and Waterlow, not whether patients developed fewer ulcers.