A Delphi Survey to Develop International Consensus on the Timeframe for Defining a Hospital-Acquired Pressure Injury (HAPI).

Abstract

To develop an international consensus on the timeframe for defining a hospital-acquired pressure injury (HAPI). The purpose of this study was to identify the time frames used internationally to report a HAPI and to obtain expert consensus on what time frame defines a HAPI. A Delphi survey was undertaken with 43 international experts from 11 countries. Three Delphi rounds were conducted over 9 months. A percentage level agreement/consensus was set at ≥ 70%. Items with < 70% were removed. This research highlighted a wide variation among international experts on the definition of a hospital-acquired pressure injury and the variation in the timeframe used in guidelines within healthcare organisations. Expert interpretations for defining a hospital-acquired pressure injury had 10 variations, ranging from zero hours on admission to 96 h after admission. After three Delphi rounds, a 100% agreement was reached by expert consensus. A hospital-acquired pressure injury was defined as occurring after the first 24 h following admission. Deep tissue injury/unstageable PIs were defined as occurring after 72 h. This study used expert consensus to define a hospital-acquired pressure injury. Previous inconsistencies in hospital-acquired pressure injury definitions have impacted incident reporting, hospital coding, and funding penalties imposed by some governments. A standard international definition will allow for international comparisons and local benchmarking of prevalence and incidence rates. Accurate benchmarking supports quality activities to improve patient outcomes. It is only at this time that this data will represent a definitive measure of quality and evidence-based practice.