AHRQ defines there PSI indicator for pressure injuries outcome measure with a facility acquired pressure injury of stage III or stage IV (excluding unstageable ulcers).Our facility is concerned with alignment across measures, this would be the 3rd reported measure for Hospital acquired pressure ulcers as there is already Magnet, HAC and now an ECQM, all with varying specifications. As a hospital we’re always striving to provide better patient care, and decreasing the number of pressure injuries is a priority. It seems it would be best for this indicator to come from an ICD 10 code (as it currently does from the PSI 3 for pressure injuries from AHRQ), as a licensed provider diagnosing pressure injuries as this would be the best and most accurate way of defining the stage of ulcer. The issue with not using ICD coding, and pulling the data from an extractable field in the flowsheet within the HER (which is possible to do), is that there is poor interrater reliability between difference in staffing and training in recognizing differing pressure injuries. Since hospitals have 1000’s of nurses, not only will it not be the same nurse every time but there could be variations of how the nurses grade the pressure injury especially when the injury is between stages. There is also misclassification among injuries (ie sheer, lacerations, abrasions etc) with various staff classifying them incorrectly. Because of this, our facility is reliant on wound care advanced practitioners to correctly diagnose and treat. These providers document in progress notes, not in an easily extractible field. Patients that are admitted with an unstageable ulcer should be excluded as there is no way to determine if the pressure ulcer is worsening during the hospital stay.

The numerator – “Proportion of hospitalized patients age 18 years or older, who suffer the harm of developing a new stage 2-4 pressure injury, deep tissue injury or unstageable pressure injury, or an existing injury that increases to stage 2-4, deep tissue, or unstageable during the measurement period.” – could accurately capture hospital acquired or worsening pressure ulcers dependent on how the data is collected (ie: ICD 10 coding or extractable fields)
Clinical concepts - this could be a burden on the current workflow. As stated earlier if using an extractable field based on nursing documentation, you would have poor interrater reliability.