Evaluation of a Modified Version of the Norton Scale for Use as a Pressure Injury Risk Assessment Instrument in Critical Care A Quality Improvement Project

PURPOSE: No risk assessment scale exists in the United States specifically designed for use among patients with critical illness. The aim of this project was to modify the Norton Scale for Pressure Sore Risk to improve its predictive power when used in the critical care setting. PARTICIPANTS AND SETTING: The setting for this quality improvement project was a 1157-bed academic medical center in the Southeast United States. Data were collected from 114 clinicians; 111 were critical care nurses and 3 were certified wound care nurses. METHODS: Participants assessed the pressure injury risks of a video-simulated critical care patient using the optimized Norton Scale (oNS); this instrument was modified from the Norton Scale. Data were collected on reliability, validity, usability, and preference. OUTCOMES: All 114 participants accurately predicted a patient's severe high risk for pressure injury using the oNS. Predictive validity and reliability of the oNS were excellent based on a correlation coefficient of more than 0.6 and a Cronbach alpha = 0.944, respectively. The intraclass correlation coefficient (ICC) was 0.933 (95% confidence interval, 0.911-0.950). From 71.2% to 84.9% of the participants agreed that the oNS represented the desired characteristics for optimal usability in the critical-care setting. Preference for the oNS was associated with perceptions that it was easier, quicker, and more critical-care-specific than the Braden Scale for Pressure Sore Risk currently used in critical care units in the project facility. IMPLICATIONS FOR PRACTICE: The oNS offered critical care nurses in our facility a quick, easy-to-use, critical care- specific risk assessment tool that focused on the unique vulnerabilities of patients with critical illness.