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Revalidation of a Perioperative Risk Assessment Measure for Skin

Meehan, Anita J.; Beinlich, Nancy R.; Bena, James F.; Mangira, Caroline

doi: 10.1097/NNR.0000000000000362

Background Validated perioperative pressure injury (PI) risk assessment measures are few and often cumbersome to complete, leading to missed opportunities to identify and target prevention interventions to those patients at increased risk for developing a postsurgical PI.

Objectives Previous validation of a six-item perioperative risk assessment measure for skin (PRAMS) was conducted in our community hospital with positive findings. The purpose of this study was to increase generalizability by revalidating the PRAMS in a larger sample.

Methods This was a retrospective chart review of all surgical patients aged ≥18 years positioned in the supine or lateral position in a Midwest quaternary care, multispecialty, 1,500-bed hospital during a 6-month period (n = 1,526). The intent of the study was to revalidate the PRAMS. The main outcome of interest was the development of PI after surgery. Risk indicators of interest included diabetes, age, surgical time, Braden score, previous surgery, and preexisting PI. The diagnostic ability of any of the risk indicators on the development of a postsurgical PI was evaluated using sensitivity, specificity, and predictive values.

Results Postsurgical PIs occurred in 121 patients. Comparing current to previous study results, the PRAMS was effective in identifying surgical patients at risk for PI (sensitivity = .98). Those patients with a postsurgical PI had a lower mean Braden score, were more likely to have a preexisting PI, and were more likely to have a previous surgery during the same admission (p < .001 for all risk indicators), comparing favorably to the original study. Patients without risk indicators were unlikely to develop a postsurgical PI (negative predictive value = .98).

Discussion Results of this validation study demonstrate that the PRAMS is effective in identifying patients who developed a postsurgical PI using information readily available to the perioperative staff.

Anita J. Meehan, MSN, RN-BC, CNOR(e), ONC, FNGNA, is Clinical Nurse Specialist, Cleveland Clinic Akron General, Ohio.

Nancy R. Beinlich, MSN, RN, CWON, is Professional Development Specialist, Cleveland Clinic Akron General, Ohio.

James F. Bena, MS, is Lead Statistician, Quantitative Health Sciences, Cleveland Clinic, Ohio.

Caroline Mangira, RN, MPH, is Biostatistician, Cleveland Clinic Akron General, Ohio.

Accepted for publication December 9, 2018.

The authors acknowledge Mark McClelland, DNP, RN, CPHQ, Cleveland Clinic, Cleveland, OH, for his support and guidance.

Cleveland Clinic Institutional Review Board approved this study under expedited review (IRB #17-198).

The authors have no conflicts of interest to report.

Corresponding author: Anita J. Meehan, MSN, RN-BC, CNOR, ONC, FNGNA, Cleveland Clinic Akron General, 1 Akron General Ave., Akron, OH 44703 (e-mail:

Online date: April 2, 2019

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