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Title: Inter-rater reliability of descriptors for the classification of mucosal pressure injury: A prospective cross-sectional study.
Austin Authors: Fitzgerald, Simone;McTier, Lauren;Whitehead, Christina;Masters, Kristy;Wynne, Rochelle
Affiliation: Intensive Care
School of Nursing & Midwifery, Deakin University, Geelong, Victoria, Australia
Western Sydney Nursing & Midwifery Research Centre, Blacktown Clinical & Research School, Western Sydney University & Western Sydney Local Health District, Blacktown Hospital, Marcel Crescent Blacktown, NSW, Australia
Centre for Quality & Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Australia
Intensive Care Unit, Nepean Hospital, Penrith, NSW, Australia
Issue Date: Mar-2023
Date: 2022
Publication information: Australian Critical Care 2023; 36(2)
Abstract: Mucosal pressure injuries (PIs) are usually caused by pressure from essential medical devices. There is no universally accepted criterion for assessment, monitoring, or reporting mucosal PI. Reliable descriptors are vital to benchmark the frequency and severity of this hospital-acquired complication. The objective of this study was to determine whether modified Reaper Oral Mucosa Pressure Injury Scale (ROMPIS) descriptors improved the reliability of mucosal PI assessment. Secondary aims were to explore nurses' knowledge of and attitudes toward mucosal PI. A prospective cross-sectional survey was distributed to nurses from two tertiary affiliated intensive care units via REDCap® to capture demographic data, knowledge, attitudes, and inter-rater reliability (IRR) measures. Nurses were randomised at a 1:1 ratio to original or modified ROMPIS descriptors and classified 12 images of mucosal PI. IRR was assessed using percentage agreement, Fleiss' kappa, and intraclass correlation coefficients. The survey response rate was 20.9% (n = 98/468), with 73.5% (n = 72/98) completing IRR measures. Agreement was higher with modified (75%) than original ROMPIS descriptors (69.4%). IRR was fair for the original (κ = 0.30, 95% confidence interval [CI] [0.28, 0.33], z 26.5, p < 0.001) and modified ROMPIS (κ = 0.29, 95% CI [0.26, 0.31], z 25.0, p < 0.001). Intraclass correlation coefficient findings indicated ratings were inconsistent for the original (0.33, 95% CI [0.18, 0.59], F 18.8 (11 df), p < 0.001) and modified ROMPIS (0.31, 95% CI [0.17, 0.57], F 17.6 (11 df), p < 0.001). PI-specific education and risk factor recognition were common. Modified descriptors had marginally better agreement. Participants understand management and prevention but need to strengthen their perceived capacity for mucosal PI risk assessment. This work provides a foundation for future benchmarking and a platform from which further research to refine and test descriptors specific to mucosal PI can be generated.
DOI: 10.1016/j.aucc.2021.12.004
ORCID: 0000-0002-5642-1205
Journal: Australian Critical Care : Official Journal of the Confederation of Australian Critical Care Nurses
PubMed URL: 34991951
PubMed URL:
ISSN: 1036-7314
Type: Journal Article
Subjects: Critical care
Critical care nursing
Nursing research
Pressure ulcer classification
Pressure ulcer nursing
Pressure ulcer prevention and control
Quality of health care
Appears in Collections:Journal articles

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