Inter-Rater Agreement of Pressure Ulcer Risk and Prevention Measures in the National Database of Nursing Quality Indicators® (NDNQI)

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Abstract

In this descriptive multi-site study, we examined inter-rater agreement on 11 National Database of Nursing Quality Indicators® (NDNQI®) pressure ulcer (PrU) risk and prevention measures. One hundred twenty raters at 36 hospitals captured data from 1,637 patient records. At each hospital, agreement between the most experienced rater and each other team rater was calculated for each measure. In the ratings studied, 528 patients were rated as “at risk” for PrU and, therefore, were included in calculations of agreement for the prevention measures. Prevalence-adjusted kappa (PAK) was used to interpret inter-rater agreement because prevalence of single responses was high. The PAK values for eight measures indicated “substantial” to “near perfect” agreement between most experienced and other team raters: Skin assessment on admission (.977, 95% CI [.966–.989]), PrU risk assessment on admission (.978, 95% CI [.964–.993]), Time since last risk assessment (.790, 95% CI [.729–.852]), Risk assessment method (.997, 95% CI [.991–1.0]), Risk status (.877, 95% CI [.838–.917]), Any prevention (.856, 95% CI [.76–.943]), Skin assessment (.956, 95% CI [.904–1.0]), and Pressure-redistribution surface use (.839, 95% CI [.763–.916]). For three intervention measures, PAK values fell below the recommended value of ≥.610: Routine repositioning (.577, 95% CI [.494–.661]), Nutritional support (.500, 95% CI [.418–.581]), and Moisture management (.556, 95% CI [.469–.643]). Areas of disagreement were identified. Findings provide support for the reliability of 8 of the 11 measures. Further clarification of data collection procedures is needed to improve reliability for the less reliable measures. © 2016 Wiley Periodicals, Inc.

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