Development of the interRAI Pressure Ulcer Risk Scale (PURS) for use in long-term care and home care settings.
BACKGROUND
In long-term care (LTC) homes in the province of Ontario, implementation of the Minimum Data Set (MDS) assessment and The Braden Scale for predicting pressure ulcer risk were occurring simultaneously. The purpose of this study was, using available data sources, to develop a bedside MDS-based scale to identify individuals under care at various levels of risk for developing pressure ulcers in order to facilitate targeting risk factors for prevention.


METHODS
Data for developing the interRAI Pressure Ulcer Risk Scale (interRAI PURS) were available from 2 Ontario sources: three LTC homes with 257 residents assessed during the same time frame with the MDS and Braden Scale for Predicting Pressure Sore Risk, and eighty-nine Ontario LTC homes with 12,896 residents with baseline/reassessment MDS data (median time 91 days), between 2005-2007. All assessments were done by trained clinical staff, and baseline assessments were restricted to those with no recorded pressure ulcer. MDS baseline/reassessment samples used in further testing included 13,062 patients of Ontario Complex Continuing Care Hospitals (CCC) and 73,183 Ontario long-stay home care (HC) clients.


RESULTS
A data-informed Braden Scale cross-walk scale using MDS items was devised from the 3-facility dataset, and tested in the larger longitudinal LTC homes data for its association with a future new pressure ulcer, giving a c-statistic of 0.676. Informed by this, LTC homes data along with evidence from the clinical literature was used to create an alternate-form 7-item additive scale, the interRAI PURS, with good distributional characteristics and c-statistic of 0.708. Testing of the scale in CCC and HC longitudinal data showed strong association with development of a new pressure ulcer.


CONCLUSIONS
interRAI PURS differentiates risk of developing pressure ulcers among facility-based residents and home care recipients. As an output from an MDS assessment, it eliminates duplicated effort required for separate pressure ulcer risk scoring. Moreover, it can be done manually at the bedside during critical early days in an admission when the full MDS has yet to be completed. It can be calculated with established MDS instruments as well as with the newer interRAI suite instruments designed to follow persons across various care settings (interRAI Long-Term Care Facilities, interRAI Home Care, interRAI Palliative Care).
Poss
Jeff
J
Department of Health Studies and Gerontology, University of Waterloo, Waterloo, ON, Canada. jwposs@healthy.uwaterloo.ca
Murphy
Katharine M
KM
Woodbury
M Gail
MG
Orsted
Heather
H
Stevenson
Kimberly
K
Williams
Gail
G
Macalpine
Shirley
S
Curtin-Telegdi
Nancy
N
Hirdes
John P
JP
D000368:Aged; D000369:Aged, 80 and over; D006699:Home Care Services / Q000639:trends*; D006707:Homes for the Aged / Q000639:trends*; D006801:Humans; D008134:Long-Term Care / Q000379:methods / Q000639:trends; D008875:Middle Aged; D009735:Nursing Homes / Q000639:trends*; D003668:Pressure Ulcer / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D012307:Risk Factors; D012720:Severity of Illness Index