Academic journal article Journal of Nursing Measurement

Validation of the NE1 Wound Assessment Tool to Improve Staging of Pressure Ulcers on Admission by Registered Nurses

Academic journal article Journal of Nursing Measurement

Validation of the NE1 Wound Assessment Tool to Improve Staging of Pressure Ulcers on Admission by Registered Nurses

Article excerpt

Background and Purpose: There is a need for a simple bedside tool to improve the ability of nurses to identify skin alterations, describe wounds, and stage pressure ulcers for proper care management and present on admission documentation. This study tests the test-retest reliability and criterion validity of the NE1 Wound Assessment Tool (NE1 WAT), a single-use tool featuring wound pictures and stage descriptions according to National Pressure Ulcer Advisor Panel criteria. Methods: Registered nurses (N = 94) identified and staged 30 wound photographs under 3 test conditions: (a) without NE1 WAT, (b) with NE1 WAT after viewing a 10-min instructional presentation, (c) with NE1 WAT but no additional instruction after a 7-14-day delay. Results: Out of a possible 90 points, scores increased 12.3 points between Tests 1 and 2 ( p <.001) and 14.1 points between Tests 1 and 3 ( p <.001). Test-retest reliability was high: intraclass correlation coefficient (ICC; 3, 1) = .892 (95% confidence interval [CI]: 0.840-0.927). Conclusions: The NE1 WAT is a simple tool that, with little training, improved the skin assessment ability of registered nurses.

Keywords: pressure ulcer; registered nurse; nursing assessment; tool validation

Skin alterations, wounds, and pressure ulcers can become serious medical conditions that require intensive efforts by nurses to assess, monitor, prevent complications, and treat. Significant financial and human costs are associated with alterations in skin integrity. In the United States, the estimated cost of care for pressure ulcers per incidence ranges from $500 to $50,000-an expenditure that can reach a total of up to $11 billion each year (Berlowitz et ah, 2011; Chan et ah, 2012; Russo, Steiner, & Spector, 2008). Pressure ulcers interfere with patient recovery and contribute to excess hospital stay, poor prognosis, and premature mortality (Berlowitz, Brandeis, Anderson, Du, & Brand, 1997; Graves, Birrell, & Whitby, 2005). An estimated 60,000 patients die each year from complications attributable to pressure ulcers (National Pressure Ulcer Advisory Panel, 2001). Accordingly, the recognition, assessment, and clinical documenta- tion of skin alterations, wounds, and pressure ulcers are important, but these activities are not always accomplished in a consistent and accurate format.

In 2008, the Centers for Medicare and Medicaid Services (CMS) added pressure ulcers to the list of hospital-acquired conditions requiring documentation of present on admission (POA) to receive full reimbursement (Centers for Medicare & Medicaid Services, 2012). CMS will base reimbursement for pressure ulcers on criteria documented at admission (Centers for Medicare & Medicaid Services, 2012; Lyder & Ayello, 2009). For Stage III and IV pressure ulcers, only those with proper POA documentation will be reimbursed at a higher diagnosis-related group rate. Pressure ulcers that develop during a patient's hospitalization or that are not documented at admission will receive no additional reim- bursement (Centers for Medicare & Medicaid Services, 2012). Thus, timely and accurate nursing assessment and documentation of skin alterations, wounds, and pressure ulcers are important for billing compliance as well as the creation of a medical treatment plan.

The NE1 Wound Assessment Tool (NE1 WAT, previously called the N.E. One Can Stage tool; NE Solutionz, LLC, Las Vegas, Nevada) was designed to facilitate this assess- ment of skin alterations, wounds, and pressure ulcers. This article presents results from testing of this tool for use by registered nurses (RNs). A preliminary study indicated that the NE1 WAT has good reliability and validity; subjects with varied levels of experience demonstrated an increased ability to identify skin alterations and accurately stage pressure ulcers with use of this tool (Young, Estocado, Landers, & Black, 2011). The study pre- sented here expands on these results by testing a slightly modified tool with RN subjects from several different geographic areas. …

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