Running head: EVIDENCE-BASED PRACTICE: PRESSURE ULCER RISK

Evidence-Based Practice:
Pressure Ulcer Risk Assessment
Elise Howard
The Pennsylvania State University

EVIDENCE-BASED PRACTICE: PRESSURE ULCER RISK

Pressure ulcers create increased portals of entry for infections and are a large strain
financially on both healthcare institutions and patients. Many medical institutions have
assessment applications in place that identify a patients current presence of pressure ulcers.
However, as nurses we can ultimately prevent pressure ulcers from occurring during their length
of stay by implementing certain actions such as applying barrier creams, placing pillows, and
frequent repositioning. We can head off a problem before it begins; as of now, there are many
institutions that have a way to assess risk of pressure ulcers, but there is limited evidence of
clinical effectiveness for a standard pressure ulcer (PU) risk assessment (Coleman et al., 2014).
Another issue that impedes the development of a standard PU risk assessment tool is the
fact that there are patients who are clearly not at risk for PUs but a fully detailed PU risk
assessment is completed on every patient. This takes away clinical nursing time that could be
dedicated to more pressing issues of the patient. With these aspects in mind, the need to
streamline the assessment of PUs to include a stage of the screening process that would permit
documentation of a patient who is plainly not at risk (Coleman et al., 2014).
The aim of the study conducted by Coleman et al. (2014) was to develop a PU risk factor
Minimum Data Set (MDS) and Risk Assessment Framework (RAF) with an objective of
establishing a list of patient characteristics to create a MDS appropriate for routine collection of
PU risk factors. Another objective was to develop an RAF that included the MDS with a) a
simple screening stage that could identify the patients who are at no risk of PUs more quickly, b)
a full assessment stage for patients who have an actual or potential risk for PUs, and c) decision
pathways based on the patients risk (Coleman et al., 2014).

EVIDENCE-BASED PRACTICE: PRESSURE ULCER RISK

The study was designed as a consensus study using a modified nominal group technique
which included face-to-face interactions with an expert group with which pre- and post-meeting
questionnaires were utilized. The expert group consisted of international researchers (nurses
academic and clinical, doctors in specialized fields, epidemiologists, bioengineers, organizational
development and clinical decision-making experts) who were identified by their publications on
PUs. Face-to-face interaction with a patient and public service user group (PURSUN; patients,
public, and care providers) was also utilized to reflect on whether or not the anticipated
assessments were feasible and tolerable (Coleman et al., 2014).
Data was collected during an initial expert meeting and an initial patient and public
involvement meeting. There were two subsequent cycles of data collection for each of the two
groups. Cycle one focused on consensus of risk factors to be included in the MDS and cycle two
focused on consensus on assessment items. While it is difficult to determine validity of
judgments based on a consensus, the process of the consensus of both the MDS risk factors and
the RAF assessment items was vigorous. The final draft of the RAF with underlying MDS can be
concisely summarized in Figure 1 (Coleman et al., 2014).
In my opinion, pressure ulcers are a very large cause for concern in any setting whether it
be in acute care, long-term care, or in the home setting. I think that this study is correct and
justified in trying to find a consensus of risk factors and assessment tools to be used to not only
identify risks of pressure ulcers, but the pathways to take once the risk has been identified. Not
only are pressure ulcers portals for infection and a large financial burden on the healthcare
system and patient, it also causes the patient additional, sometimes unrelated pain. I think of
pressure ulcers like preventable diseases, they still occur in large numbers, but we can implement
actions that will reduce that number greatly. With a tool of risk assessment such as the one

EVIDENCE-BASED PRACTICE: PRESSURE ULCER RISK

proposed here, I believe that we can not only decrease the number of pressure ulcers, but also
spend our time more wisely with patients who clearly do not need further, in-depth assessment.
As nurses, out time will be precious so we need to spend it judiciously and the no risk
assessment stage will help greatly with this.

Figure 1. Final draft of RAF with underlying MDS.

EVIDENCE-BASED PRACTICE: PRESSURE ULCER RISK

REFERENCES
Coleman, S., Nelson, A. E., Keen, J., Wilson, L., McGinnis, E., Dealey, C., . . . J. M.
(2014). Developing a pressure ulcer risk factor minimum data set and risk
assessment framework. Journal of Advanced Nursing, 70(10), 2339-2352.
Retrieved from http://dx.doi.org.ezaccess.libraries.psu.edu/10.1111/jan.12444