The development of a Pressure Ulcer Risk Assessment Framework and Minimum Data Set

Background: Pressure ulcers are associated with ill health and poor mobility and are a considerable healthcare problem worldwide. Risk assessment is considered the cornerstone to pressure ulcer prevention. Aim: To develop a Risk Assessment Framework for use with adult populations in clinical practice, underpinned by a risk factor Minimum Data Set. Methods: The methodological approach comprised 4 phases: 1) Systematic review of pressure ulcer risk factors. 2) Consensus study involving 17 international experts with service user involvement. 3) Conceptual framework and theoretical causal pathway development. 4) Design and pre-testing of the draft Risk Assessment Framework using cognitive pre-testing methods, incorporating 3 sessions and 34 nurses. Results: 1) The review of 54 studies identified 3 primary risk factor domains, mobility/activity, skin/pressure ulcer status and perfusion (including diabetes), but suggests no single factor can explain pressure ulcer development. 2) The consensus study facilitated the agreement of risk factors and assessment items of the Minimum Data Set (including immobility, pressure ulcer and skin status, perfusion, diabetes, skin moisture, sensory perception and nutrition), allowing the development of a draft Risk Assessment Framework. 3) The new conceptual framework incorporates key physiological and biomechanical components and their impact on internal strains, stresses and damage thresholds. Direct and key indirect causal factors suggested in the theoretical causal pathway are mapped to the physiological and biomechanical components of the framework. 4) The design and pre-testing of the Risk Assessment Framework confirmed content validity and led to improved usability over the course of the pre-test. The preliminary Risk Assessment Framework incorporates the Minimum Data Set, a 2 stage assessment process (screening and full assessment), support for decision making and primary prevention and secondary prevention/treatment pathways. Conclusion: The resulting Risk Assessment Framework makes an important contribution to the pressure ulcer field and now requires further clinical validation and evaluation