5Local study compared the predictive power of different assessment tools in a hospital & recommended using Braden ScaleNote: Involve Gd 1 sore in sore formation
6How to select the most appropriate instrument? As an administrator, one should know how to evaluate the utilization of tool in the setting continuously
7e.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 insertionIncontinence: Not (4), Occasionally (3),Usually (2), Double (1)Double (1): Never able to control bowel and bladder function, has 7-10 episodes in 24 hoursUsually urine (2):3-6 episodes of urinary incontinence or diarrhoeal stools in 2 hoursOccasionally (3): 1-2 episodes of urine/feces in 24 hours, has condom catheter, has Foley catheter but has incontinent stools
8Continuous ward level education Posting-up scoring system
92. 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)
10Risk 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%]
11Other measures Appropriate selection of pressure relieving system Appropriate turning scheduleIdentification of pressure area
12Stage 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.