title: Inter-rater reliability of the Reaper Oral Mucosa Pressure Injury Scale (ROMPIS): A novel scale for the assessment of the severity of pressure injuries to the mouth and oral mucosa.
abstract: BACKGROUND
  Patients who are intubated in the ICU are at risk of developing pressure injuries to the mouth and lips from endotracheal tubes. Clear documentation is important for pressure wound care; however, no validated instruments currently exist for the staging of pressure injuries to the oral mucosa. Instruments designed for the assessment of pressure injuries to other bodily regions are anatomically unsuited to the lips and mouth.
  
  
  OBJECTIVE
  This study aimed to develop and then assess the reliability of a novel scale for the assessment of pressure injuries to the mouth and oral mucosa.
  
  
  METHODS
  The Reaper Oral Mucosa Pressure Injury Scale (ROMPIS) was developed in consultation with ICU nurses, clinical nurse educators, Intensivists, and experts in pressure wound management. ICU nurses and portfolio-holders in pressure wound care from Peninsula Health (Victoria, Australia) were invited to use the ROMPIS to stage 19 de-identified clinical photographs of oral pressure injuries via secure online survey. Inter-rater reliability (IRR) was calculated using Krippendorff's alpha (α).
  
  
  RESULTS
  Among ICU nurses (n=52), IRR of the ROMPIS was α=0.307; improving to α=0.463 when considering only responses where injuries were deemed to be stageable using the ROMPIS (i.e. excluding responses where respondents considered an injury to be unstageable). Among a cohort of experts in pressure wound care (n=8), IRR was α=0.306; or α=0.443 excluding responses indicating that wounds were unstageable.
  
  
  CONCLUSIONS
  An instrument for the assessment and monitoring of pressure injuries to the mouth and lips has practical implications for patient care. This preliminary study indicates that the ROMPIS instrument has potential to be used clinically for this purpose; however, the performance of this scale may be somewhat reliant on the confidence or experience of the ICU nurse utilising it. Further validation is required.
authors.affiliation: Department of Intensive Care, Peninsula Health, Australia.
authors.forename: Sue
authors.initials: S
authors.lastname: Reaper
authors.affiliation: Department of Intensive Care, Peninsula Health, Australia. Electronic address: CGreen@phcn.vic.gov.au.
authors.forename: Cameron
authors.initials: C
authors.lastname: Green
authors.affiliation: Department of Intensive Care, Peninsula Health, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
authors.forename: Sachin
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Intensive Care, Peninsula Health, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
authors.forename: Ravindranath
authors.initials: R
authors.lastname: Tiruvoipati
mesh_terms: D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects; D009055:Mouth / Q000293:injuries; D009730:Nursing Assessment; D011312:Pressure; D015203:Reproducibility of Results; D014739:Victoria; D014947:Wounds and Injuries / Q000209:etiology; D003668:Pressure Ulcer / Q000175:diagnosis
keywords: Assessment; Critical care; Inter-rater reliability; Pressure injury; Pressure wound; Quality