METHODS
INTRODUCTION RESULTS CONCLUSIONS
1. An answer sheet based on NDNQI classification system was given to each CSI, and instructions were provided on how to fill out the questionnaire. Slides were presented depicting various types of wounds and various stages of pressure ulcers.
2. The CSIs were instructed to identify the type of ulceration (arterial ulcer, diabetic ulcer, perineal dermatitis, pressure ulcer, skin tear or venous ulcer) in the 1st column. In the 2nd column, participants identified the stage of the pressure ulcer, and were told to leave the 2nd column blank if it was arterial, diabetic or venous ulcer, perineal dermatitis or skin tear.
3. After test sheets were submitted, the WOC nurse discussed each wound and clarified type, characteristics, and stage (for pressure ulcers).
4. We then analyzed the answers to obtain average scores. 5. This test was given every 3 months to evaluate the CSIs’ progress in
understanding how to stage pressure ulcers and how to classify wounds.
PURPOSE Assure accurate classification of pressure and non-pressure ulcer wounds and accurate staging of pressure ulcers by Champion of Skin Integrity (CSI) nurses.
BACKGROUND Every bedded unit in our facility has a CSI, who acts as a resource nurse on their own unit/floor. One of the CSI's responsibilities is to participate in the quarterly NDNQI Prevalence Study. The WOC nurses sought to improve CSIs’ accuracy in wound classification and pressure ulcer staging by conducting Inter-rater Reliability testing of wound classification and pressure ulcer staging prior to each quarterly NDNQI survey for over 1 year. The reliability test consisted of pictures of different stages of pressure ulcers, and non-pressure wounds such as venous and arterial ulcers, diabetic ulcers, moisture associated skin damage, and skin tears. After the test, each wound was discussed in terms of characteristics, classification (wound types), and stage (for pressure ulcers). We used this testing to determine whether quarterly education improved CSI classification of wound type and staging of pressure ulcers.
The data indicate that simple strategies can be effective in improving staff nurse accuracy in wound classification and pressure ulcer staging.
Accurate classification and staging of pressure ulcers will always be a challenge since patients tend to manifest with multiple wounds and co-morbidities.
CSIs are encouraged to always consider wound locations and characteristics as well as patient history as a basis for determination of wound etiology.
We are working to further advance CSI proficiency in identification of pressure ulcers and other types of wounds through ongoing education and use of our online resources.
Inter-rater Reliability of Pressure Ulcer Identification and Staging Name Date
Number Type of Ulceration Pressure Ulcer Stage A = Arterial D = Diabetic S = Skin Tear
P = Pressure Ulcer V = Venous Ulcer PD = Perineal Dermatitis
1.
2.
I, II, III, IV, sDTI, Unstageable
Results of Inter-rater Reliability Testing of Classification of Wounds
Table 1 / Graph 1: This table and graph show the percentage of correct classification of each type of wound from April 2014 through April 2015.
The table and graphs show the improvement in the identification of different types of ulcerations. The decrease in accurate classification of venous ulcers in January 2015 and Stage IV pressure ulcers in April 2015 is hypothesized to be due to the large number of new CSIs who had not gone through the same amount of training as other participants. Overall, the data show improvement in the competency of the CSIs in staging of pressure ulcers and identification of other types of wounds.
Graph 2: This table shows the average scores in April 2014 and April 2015 for each stage of pressure ulcers.
Aileen Ankrom, BSN, RN, CWOCN; Cynthia Timms, BSN, RN, CWOCN; Angela Dye, BSN, RN, CWOCN Emory University Hospital
Competency of Champions of Skin Integrity (CSI) in Staging of Pressure Ulcers and Identification of Other Types of Wounds
ACKNOWLEDGEMENTS
The Champions of Skin Integrity
I II III IV US DTI April 2014 84.21% 76.32% 57.89% 65.79% 66.67% 72.37%
April 2015 94.59% 89.19% 75.68% 62.16% 81.08% 93.24%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Perc
enta
ge C
orre
ct
Stages of Pressure Ulcer
Stages of Pressure Ulcer
0%
20%
40%
60%
80%
100%
120%
April 2014 July 2014 October 2014
January 2015 April 2015
Perc
enta
ge C
orre
ct
Tes�ng Month
Classifica�on of Types of Ulcera�ons or Wounds
Arterial
Diabe�c Ulcer
Perineal Derma��s
Pressure Ulcer
Skin Tear
Venous Ulcer
Classifica�on of Types of Ulcera�ons or Wounds
72.97%
23.68%
REFERENCES
Berquist-Beringer, S. & Davidson, J. (2015). NDNQI. Retrieved from https://members.nursingquality.org/NDNQIPressureUlcerTraining/
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! Percentage)Correct)April)2014) Percentage)Correct)April)2015)Arterial)Ulcer) 23.68%! 72.97%!Diabetic)Ulcer) 81.58%! 86.49%!
Perineal)Dermatitis) 89.47%! 94.59%!Skin)Tear) 78.95%! 100.00%!
Venous)Ulcer) 68.42%! 86.49%!Pressure)Ulcer) 91.35%! 94.98%!
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