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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