Inter-rater reliability of descriptors for the classification of mucosal pressure injury: A prospective cross-sectional study

Abstract

Background: 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.Objectives: 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. Methods: 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. Results: The survey response rate was 20.9% (n ¼ 98/468), with 73.5% (n ¼ 72/98) completing IRR measures. Agreement was higher with modified (75%) than original ROMPIS descriptors (69.4%). IRR was fair for the original (k ¼ 0.30, 95% confidence interval [CI] [0.28, 0.33], z 26.5, p < 0.001) and modified ROMPIS (k ¼ 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. Conclusion: 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.

Incidence and characteristics of hospital‐acquired mucous membrane pressure injury: A five‐year analysis

“…In reliability testing using photographs, the ROMPIS demonstrated ‘fair’ interrater reliability between 52 intensive care nurses, and between eight pressure wound management experts (Reaper et al, 2017). More recently, the ROMPIS MMPI staging descriptors were updated by an expert panel of intensive care nurses (Fitzgerald et al, 2022). In testing of the original and modified versions using images, interrater reliability between 72 nurses was fair for both, although better for the modified version (Fitzgerald et al, 2022).…”

“…More recently, the ROMPIS MMPI staging descriptors were updated by an expert panel of intensive care nurses (Fitzgerald et al, 2022). In testing of the original and modified versions using images, interrater reliability between 72 nurses was fair for both, although better for the modified version (Fitzgerald et al, 2022). Nonetheless, this has provided a starting point for MMPI staging which requires further development and research.…”

Assessment, management and prevention of chronic wounds in the Australian context: a scoping review

“…Several studies assessed validity and reliability of risk assessment tools, including Waterlow 106,132 , Ramstadius 106 , the Northern Hospital-Pressure Ulcer Prevention Plan (TNH-PUPP) 133 , Glamorgan Scale 134 , Conscious level, Mobility, Haemodynamics, Oxygen, Nutrition (COMHON) Index 135 , Reaper Oral Mucosa Pressure Injury Scale (ROMPIS) 136 , modified ROMPIS 137 , Braden Score 138,139 , and the interRAI scale 112 . Risk factors for developing PIs are shown in Table 6.…”