1. Monitoring pressure sore risk assessment tool in hospital
Chung Tak Ki
Nurse Specialist (Geri)

2. Prevent sore development
Norton score
Braden scale

3. Sore risk assessment is the first step in determining patient’s need for preventive measures
Benchmarking Consortium recommended using Norton Score in extended care setting

5. Local study compared the predictive power of different assessment tools in a hospital & recommended using Braden Scale
Note: Involve Gd 1 sore in sore formation

6. How to select the most appropriate instrument?
As an administrator, one should know how to evaluate the utilization of tool in the setting continuously

7. e.g. Patient with foley insertion
1. The definition for the scoring is always neglected. By exploring knowledge of NS, the average understanding on the scoring was only 52%
e.g. Patient with foley insertion
Incontinence: Not (4), Occasionally (3),
Usually (2), Double (1)
Double (1): Never able to control bowel and bladder function, has 7-10 episodes in 24 hours
Usually urine (2):3-6 episodes of urinary incontinence or diarrhoeal stools in 2 hours
Occasionally (3): 1-2 episodes of urine/feces in 24 hours, has condom catheter, has Foley catheter but has incontinent stools

8. Continuous ward level education
Posting-up scoring system

9. 2. Cut-off point of the scale should be monitored
e.g. Sensitivity of Norton score for cut-off point 14 =74% (54% for cut-off point 12 in 2000)

10. Risk group proportion = (a+b)/(a+b+c+d) x 100%
Sensitivity: The proportion of positive test obtained in patients with diagnosis
[Sensitivity = a/(a+c) x 100%]
Positive predictive value: The proportion of those with diagnosis who were predicted to have them [PV+ = a/(a+b) x 100%]

11. Other measures Appropriate selection of pressure relieving system
Appropriate turning schedule
Identification of pressure area

12. Stage 1 sore identification
Reactive hyperaemia:The effect of pressure is the occlusion of blood supply. A release of pressure produces sudden increase in blood flow (i.e. bright red flush)
Erythema: Redness of skin surface produced by vasodilatation (redness persists 30 min after relief of pressure)
Fingertip test: Pressure is applied to reddened area. (1) If it results in skin blanching (microcirculation is intact), (2)If it does not result in skin blanching, then tissue damage has begun non-blanching hyperaemia.
In dark-skinned patients, it is often difficult to detect erythema of skin. Other manifestations are local changes in (1) skin temperature and (2) skin texture. The immediate response of inflammation of tissue is seen by an increase in skin temperature. As tissue becomes more disturbed, the temperature decreases. Skin texture may feel hard & indurated.

13. Thank you