Reliability of pressure ulcer staging: a review of literature and 1 institution's strategy

Abstract

Pressure ulcers are an increasing health care problem. Accurate identification and classification of pressure ulcers impacts patient outcomes, health care costs, and quality initiatives.To identify existing evidence related to answering the question "Does bedside nursing staff accurately and reliably stage pressure ulcers as evidenced in their documentation?" Further evidence from one large tertiary care center with pressure ulcer identification and staging by nurses is also reported. Cumulative Index to Nursing and Allied Health Literature and MEDLINE databases were searched to identify existing evidence on the accuracy and reliability of pressure ulcer classification by nurses. Two reviewers independently screened results. A total of 54 full-text articles were obtained for review and 10 were included for final review. In addition, the accuracy and consistency of pressure ulcer identification and staging were examined at one large tertiary health system by extracting data from electronic health records for 1488 patient visits and assessments for 1499 patients. Comparisons were done for pressure ulcer documentation from 1 nurse's assessment to the following shift nurse's assessment and from the bedside nurse's assessment to assessments done by pressure ulcer experts.Review of the literature revealed that the reliability of pressure ulcer identification and classification is limited and highly variable. Some reports in the literature suggested nurses had difficulty distinguishing a pressure ulcer from other types of wounds. In addition, inaccuracies in pressure ulcer documentation were also identified. Further analysis of data within one large tertiary health care system revealed unreliable pressure ulcer documentation.