QUERI – Quality Enhancement Research Initiative

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Spinal Cord Impairment Pressure Ulcer Monitoring Tool (SCI PUMT)

Individuals with spinal cord impairment (SCI) are at extreme risk for developing pressure ulcers (PrUs) over their lifetime due to immobility, lack of sensation, moisture, and other risk factors. PrU prevalence and recurrence rates are extremely high in persons with SCI.

Toolkit Element

Description

Visual Tools

1. Overview and Guidelines of SCI-PUMT (video)

Description of the SCI-PUMT development and key points to each variable.

2. SCI-PUMT development process

Evidence supporting the reliability, validity, and sensitivity of SCI-PUMT.

3. Introduction to the SCI-PUMT (video)

Clinician demonstration of PrU assessment using SCI-PUMT on life-sized manikin.

4. Clinical Issues Affecting Reliability of the SCI-PUMT (video)

Challenges in establishing reliability with PrU assessment using SCI-PUMT.

Training Tools

5. Training Flyer

Training announcement (can be adapted for local facility)

6. SCI-PUMT Tool

Word copy of the SCI-PUMT

7. Staff Knowledge Verification

Staff SCI-PUMT knowledge test.

8. Staff Competency Verification

SCI-PUMT proficiency verification procedures for SCI-PUMT items and positioning.

Cognitive Aids

9. Quick Reference Guidelines

General guidelines for using the SCI-PUMT, assessment, and key points for each item.

10. Healing Graph

Plot SCI-PUMT scores for up to 12 weeks to track PrU healing trajectory.

11. Facility Implementation Plan

Framework to enable each facility to plan and execute strategies for marketing to key stakeholders, evaluate local barriers, conduct on-site staff training, and other aspects of implementation.

12. Pocket Guide

Pocket guide with pictures of PrU and key points for each SCI-PUMT item.

13. Guidelines for Overcoming Barriers

Barriers, goals, and strategies for overcoming hurdles to SCI-PUMT implementation.

The Consortium for Spinal Cord Medicine developed a clinical practice guideline (CPG) addressing PrU risk, prevention and management in persons with SCI. The CPG recommends that the treatment plan be modified if there is no evidence of healing within a 2-4 week period. The CPG recommends use of a reliable and valid assessment tool to evaluate healing over time. The National Pressure Ulcer Advisory Panel/European Pressure Ulcer Advisory Panel CPG also recommends using a validated measurement tool to assess PrU healing.

In 2006, VA SCI/D Services sponsored a PrU Collaborative that included nurses and physicians from all 24 VA SCI Centers. Participants expressed their perceptions that existing instruments were too long and/or did not capture essential information necessary to make day-to-day clinical decisions for PrUs in persons with SCI.

This led Drs. Audrey Nelson and Susan Thomason and colleagues at the Tampa VA to develop the SCI Pressure Ulcer Monitoring tool (SCI-PUMT), a validated tool for monitoring PrU healing in people with SCI.

The goal of the SCI-PUMT toolkit is to enhance implementation of the SCI-PUMT by SCI clinicians.

Citations

  1. Thomason SS, Luther SL, Powell-Cope GM, Harrow JJ, Palacios P. Validity and reliability of a pressure ulcer monitoring tool for persons with spinal cord impairment. J Spinal Cord Med. 2014 May;37(3):317-27. PMID: 24621044
  2. Thomason S, Powell-Cope G, Peterson MJ, Guihan M, Wallen ES, Olney CM, Bates-Jensen, BM. A multi-site quality improvement project to standardize the assessment of pressure ulcer healing in Veterans with spinal cord injuries/disorders. Advances in Skin and Wound Care. (In press, accepted 9/5/14).