Despite numerous efforts to decrease pressure ulcer development, current estimates are still above an acceptable incidence rate of less than 2%.1
Higher incidences of pressure ulcers have been reported in acute care settings (0.4% – 38 %) than in long-term care facilities (2.2 % – 23.9%).2
The incidence of pressure ulcers is likely to rise in the future due to increasing acuity and severity of illness and a larger aging population in acute care settings.3
It is well known that pressure ulcer development is directly associated with increasing lengths of stay and healthcare costs and may lead to decreased quality of life.4
According to the current best evidence, preventive measures (e.g., repositioning, support surfaces, nutritional interventions) should be initiated in a timely manner after identifying at-risk individuals.5–6
To date, the recommended timing is to evaluate patients in acute care settings for early detection on the day of admission and to reevaluate the plan of care within 48 to 72 hours after admission.7
As such, the National Quality Forum (NQF) has designated initial and regular risk assessments for pressure ulcer development as a “safe practice” for the nation’s health.8
Risk assessment as “an integral part of prevention efforts” involves examining the patient’s skin integrity and level of risk with predisposing factors. 9
Risk factors can be defined as anything that increases the susceptibility of individuals for developing pressure ulcers. The body of literature, however, has shown considerable variations in study designs and methods, sample populations, healthcare settings, data sources, and operational methods for defining the variables. Subsequently, the relationships among risk factors studied (e.g., age, mobility, activity, incontinence, malnutrition) have varied, depending on the set of variables entered into analyses. Therefore, previous studies make it difficult to compare and generalize causal relationships between risk factors and pressure ulcer development thus, enlarging a gap between evidence and practice. Using risk assessment tools allows clinicians to make better decisions in determining at-risk individuals and initiating preventive measures.6
The current best evidence recommends the use of the Norton and the Braden scales because of acceptable reliability and validity of the tools. 5–6
The Norton scale is derived from five clinical determinants of pressure ulcer risk (including physical condition, mental condition, activity, mobility, and incontinence) and the Braden scale is composed of six subscales (sensory perception, activity, mobility, moisture, friction and sheer, and nutrition). In both, individuals are classified into an at-risk group versus a not-at-risk group by a cut-off point (i.e., threshold). Each subscale score along with a total score has been investigated as a predictor for pressure ulcer development. Yet, the quality of assessment tools is of some concerns because the tools fail to consider all relevant risk factors so that they may fail to identify all who may benefit from interventions to prevent pressure ulcers.
In sum, further work is needed to refine the tools to provide optimal quality of care for at-risk patients considering patients’ level of risk.6
This study, thus, was designed to develop a predictive model with a set of risk factors for pressure ulcer formation in hospital settings.