Design: Clinical tool development and pilot testing including interview feedback from nurses using the tool.

Population and Setting: Nurses who perform PU risk assessments on residents admitted to a large publicly sponsored nursing facility.

Concept: The use of traditional PU risk scales in addition to the PU risk tool imbedded in the federally mandated nursing home Minimum Data Set (MDS) can result in duplication of effort. Furthermore, the commonly used Braden Scale (BS), does not prompt clinicians to investigate several risk factors of particular importance in the nursing home population. Quality monitoring in this facility indicated that PUs related to these unrecognized factors had occurred. Improvement in identification of PU risk and subsequent care planning was needed.

Methods: The new tool was designed based on items from the BS, MDS and factors identified through facility QI monitoring in the population being served. Registered nurses on the admission unit completed both the new form and BS on newly admitted residents. A BS score of 18 or less triggered risk, while the identification of any one factor and concurrent clinical assessment of the need for care planning determined risk using the new tool. Nurses were interviewed to determine the perceived usefulness of the new tool as compared to the BS.

Conclusions: The new tool and the BS identified the same residents as at risk for PUs. Users perceived that the structure of the new tool based on an evaluative rather than a numeric model more adequately supported risk assessment and targeted care planning in the nursing home setting, and better supported the federally mandated assessment process.

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