Free paper: A comparison of pressure ulcer risk assessment tools in palliative care

Abstract

Aim: To investigate which of three pressure ulcer risk assessment tools is most suitable for assessing the risk of patients admitted to a palliative care unit. Method: A prospective cross-sectional study with data collected at admission and discharge or death on all consenting patients admitted over a 12-week period. Data included the risk assessment score of the currently used Waterlow tool, the Walsall tool used by the community nurses, the Hunters Hill palliative care tool!, skin condition and mattress in use. Results: A total of 74 patients took part, of whom 38 had pressure damage on admission, although for 68% this was grade 1. The Walsall tool had the highest sensitivity (89%), compared to the Waterlow (34%) and Hunters Hill (18%). The Hunters Hill tool had the higher specificity at 83%, compared to the Waterlow tool (67%) currently in use. The Kappa test indicated substantial agreement between the assessed risk and the nurses' clinical judgment of risk in relation to the Walsall tool (Kappa = 0.75) and the Hunters Hill tool (Kappa = 0.73), but only fair agreement for the Waterlow tool (Kappa = 0.38).