title: Unavoidable Pressure Ulcers: Development and Testing of the Indiana University Health Pressure Ulcer Prevention Inventory.
abstract: OBJECTIVE
  Despite prevention strategies, hospital-acquired pressure ulcers (HAPUs) continue to occur in the acute care setting. The purpose of this study was to develop an operational definition of and an instrument for identifying avoidable/unavoidable HAPUs in the acute care setting.
  
  
  METHODS
  The Indiana University Health Pressure Ulcer Prevention Inventory (PUPI) was developed and psychometric testing was performed. A retrospective pilot study of 31 adult hospitalized patients with an HAPU was conducted using the PUPI.
  
  
  RESULTS
  Overall content validity index of 0.99 and individual item content validity index scores (0.9-1.0) demonstrated excellent content validity. Acceptable PUPI criterion validity was demonstrated with no statistically significant differences between wound specialists' and other panel experts' scoring. Construct validity findings were acceptable with no statistically significant differences among avoidable or unavoidable HAPU patients and their Braden Scale total scores. Interrater reliability was acceptable with perfect agreement on the total PUPI score between raters (κ = 1.0; P = .025). Raters were in total agreement 93% (242/260) of the time on all 12 individual PUPI items. No risk factors were found to be significantly associated with unavoidable HAPUs.
  
  
  CONCLUSIONS
  An operational definition of and an instrument for identifying avoidable/unavoidable HAPUs in the acute care setting were developed and tested. The instrument provides an objective and structured method for identifying avoidable/unavoidable HAPUs. The PUPI provides an additional method that could be used in root-cause analyses and when reporting adverse pressure ulcer events.
authors.affiliation: Joyce Pittman, PhD, RN, ANP-BC, FNP-BC, CWOCN, Wound/Ostomy Team, Indiana University Health-Methodist, Indianapolis, and Adjunct Assistant Professor, Indiana University School of Nursing, Indianapolis. Terrie Beeson, MSN, RN, CCRN, ACNS-BC, Indiana University Health Colin Terry, MS, Indiana University Health Jill Dillon, MSN, RN, CCRN, ACNS-BC, Indiana University Health Charity Hampton, BSN, RN, CCRN, Indiana University Health Denise Kerley, BSN, RN, CNRN, Indiana University Health Judith Mosier, BSN, MS, RN, CWOCN, Indiana University Health Ellen Gumiela, BSN, RN, Indiana University Health Jessica Tucker, BSN, RN, Indiana University Health.
authors.forename: Joyce
authors.initials: J
authors.lastname: Pittman
authors.forename: Terrie
authors.initials: T
authors.lastname: Beeson
authors.forename: Colin
authors.initials: C
authors.lastname: Terry
authors.forename: Jill
authors.initials: J
authors.lastname: Dillon
authors.forename: Charity
authors.initials: C
authors.lastname: Hampton
authors.forename: Denise
authors.initials: D
authors.lastname: Kerley
authors.forename: Judith
authors.initials: J
authors.lastname: Mosier
authors.forename: Ellen
authors.initials: E
authors.lastname: Gumiela
authors.forename: Jessica
authors.initials: J
authors.lastname: Tucker
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D003668:Pressure Ulcer / Q000517:prevention & control*; D011594:Psychometrics; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D017592:Skin Care