The Contruction Andapplication Of The Risk Assessment Scale For Medical Adhesive-related Skin Injury In Infants And Toddlers

1 BackgroundMedical adhesive is widely used in medical care environment,but the skin injury caused by it has not been paid enough attention by medical staff.The International Skin Care and Ostomy Care Association issued an expert consensus in 2013,stating that medical adhesive-related skin injury(MARSI)should be highly valued,meaning that after the removal of the medical adhesive,the skin appears erythema with or without blistering,erosion or tearing for 30 minutes or longer.If the medical adhesive is used improperly,the skin epidermis may be removed together when the adhesive is removed,resulting in the destruction of skin integrity,resulting in pain,infection,enlarged wound area and delayed wound healing,thereby reducing the patient's quality of life and increasing the medical burden on patients and society.Medical adhesives in intensive care units are essential medical supplies at home and abroad,with patient use rates approaching 100%.Therefore,developed countries such as the United States and Canada have taken the lead in incorporating medical adhesive-related skin lesions into the nursing risk assessment program,and have applied the relatively mature MARSI risk early warning control system in clinical application and evaluation.In China,adult patients often use the pressure ulcer risk assessment scale;however,there are few reports on children's MARSI,especially for infants and young children.At present,there are no targeted assessment tools,standard preventive measures and management systems.At present,most children's skin damage or pressure sore risk assessment tools are aimed at children over 7 years old,and the indicators of mobility(walking and sitting)are not suitable for infants and young children;The Chinese version of the Newborn Skin Risk Assessment Scale and the Neonatal Skin Condition Scale are not fully applicable to MARSI's risk assessment.Therefore,the MARSI risk assessment tool for infants and young children needs to be developed.2 ObjectiveTo construct scientific Risk Assessment Scale for Medical adhesive-related Skin injury in infants and toddlers in hospital through literature review and expert interviews and make reliability analysis and boundary value determination to explore its clinical application.3 MethodsThe research include two parts:the first part is forming stage of the Risk Assessment Scale.Through the review of literature,the risk factors of MARSI were selected,and 13 experts in pediatric clinical nursing,nursing management and other related research fields were selected for consultation interviews to determine the dimensions and entries of the scale,and to Construct a risk assessment scale for Medical adhesive-related Skin injury in infants and toddlers in hospital.The second part is the clinical application evaluation stage of the scale.The 293 hospitalized children who meet the criteria for inclusion and exclusion will be studied Inclusion criteria:?Infants and young children who are using medical adhesives,age 0-3 years old,gender is not limited;?skin lesion area?10%of body surface area;?parents of children agree to participate in this clinical observation and sign informed consent Exclusion criteria:?congenital skin diseases,infectious diseases and immune system diseases;?in the course of observation,other diseases require the use of glucocorticoids,immunosuppressive agents.The scale will be used to assess the risk of Medical adhesive-related Skin injury in infants and toddlers and conduct reliability validity analysis of the scale.The prediction accuracy of the scale was measured by using receiver operation characteristic curve,and the diagnostic boundary value was determined.After the scale was constructed,the researchers interviewed the pediatric clinical nurses who used the scales,used semi-structured interviews,and interviewed participants to determine interview time,interview locations,and interview methods.Interviewers prepared the interview outline in advance.Seven nurses used the lunch break for interviews.The interview time was 40 minutes.Two nurses used WeChat interviews.The interview time was 45 minutes.One nurse provided a paper-based answering material based on the interview questions.All interviews were done by the researchers themselves.4 Results4.1 Experts enquiry resultsThe study selected 15 experts from three cities in Guangdong Province(Guangzhou,Foshan,and Zhaoqing).The selection criteria are:?pediatrics in the field of work research;?bachelor degree or above;?middle-level titles with higher or higher professional titles or head nurses and above;?professional fields for at least 5 years;?voluntary participation in the study.During the expert consultation,15 experts were invited in the first round of survey,recycling 13 efficacious questionnaire,the questionnaire recovery was 86.70%,effective rate was 69.20%;13 experts to participate in the second round of survey,recycling 13 efficacious questionnaire,the questionnaire recovery was 100%,effective rate was 46.0%.4.2 The contruction of the risk assessment scale for Medical adhesive-related Skin injurySearch for MARSI related literatures at home and abroad for nearly 10 years.The query period is from January 1,2009 to December 31,2018.The source of the literature is Pubmed and China Knowledge Network.The keyword is MARSI(medical viscose-related skin damage);Pressure sore and Adhesive;skin injury and Adhesive,a total of 79 target documents were screened out There were 9 causes of skin damage with the highest frequency in the literature,including limb sensation,dampness,dryness,edema,physical activity,nutritional status,and repeated pasting.,removal method error and adhesive texture.This study determined the Risk Assessment Scale for Medical adhesive-related Skin injury in infants and toddlers contains two dimensions:Physical basis state and Local skin glue status,total of 17 items,using 1-4 points scoring system,each item is graded and assigned in turn.Using the Delphi expert consultation method,the experts were invited to conduct the first round of consultation and discussion using E-mail and paper questionnaires.The consultation content is to judge whether the important index and degree of high-risk factors are reasonable,and the consultation results are recovered within two weeks.This will determine the first draft of the MARSI Risk Assessment Scale for Infants and Children,including entries,levels and scores.The pediatric nurse used the first draft of the scale to evaluate the child.Finally,send the pre-test data analysis results and nurses' feedback to the experts involved in the first round of consultation,invite them to conduct a second round of discussion and revision on the first draft of the scale,summarize and sort out the expert opinions,and determine the final MARSI risk assessment scale for infants and young children.draft.A total of 2 first-level indicators were constructed,including the basic state and local skin viscose status;and 17 secondary indicators.The total score of the scale is 17-68.The higher the score,the greater the risk of MARSI.4.3 Clinical application evaluation results of infant medical adhesive-related skin injury risk assessment scaleThe scale evaluation 340 cases of children actually,effective questionnaire was 293,effective questionnaire recovery was 86.18%.Of the 293 children,136(46.42%)were male and 157(53.58%)were female;69(23.55%)were ?1 year old,and 103(35.15%)were 1-2 years old,121(41.30%)were 2-3 years old.The diagnosis mainly included intussusception,convulsions,severe pneumonia,severe hand,foot and mouth disease,etc.;the length of hospital stay was(7.67±2.20)days.There was 51 cases happen medical adhesive-related Skin injury,the incidence was 17.41%.The area under the ROC curve(AUC)of the total score of this scale is 0.917,and the P value is<0.05,indicating that this risk assessment scale has a strong predictive ability for medical adhesive-related skin lesions in hospitalized children with PICU.The sensitivity,specificity,positive predictive value and negative predictive value of the disease diagnosis were 86.27%,98.76%,93.60%,and 97.80%,respectively.The counts in the clinical score were all integers.According to the ROC curve coordinate value in the study,the diagnostic threshold was Determined to be 28 points,the prediction results of this scale are the most accurate.In this study,two pediatric nurses were evaluated at the same time,and a total of 293 children were evaluated.Spearman correlation analysis was used to calculate the inter-rate reliability of each item in the scale.The result of the item analysis showed that the correlation coefficient of the total scores of the two scores was 0.847,and the correlation coefficient of each item score was greater than 0.7,indicating that the reliability of the scores of the scale entries was goodTo further explore the validity of the scale entry design,logistic regression analysis was performed.The results showed that the "body type" and "whether hair cut" items were assigned the same scores for all scales(both 1 point)and could not enter the regression equation.The results of single factor logistic regression analysis of the remaining 15 items showed that the results of single factor regression analysis were not statistically significant except for the"viscose site" item.The results of single factor logistic regression analysis showed that it had an effect on MARSI.Univariate regression analysis of meaningful entries for multivariate logistic regression analysis showed sensory,wet,edematous,erythema breakage,total duration of attachment,frequency of replacement,flatness,edge curling,and skin protection agent for a total of 9 items.All of them are greater than 1,which proves that these 9 items are independent risk factors of MARSI,which is especially important in the setting of the scale and is indispensable.4.4 Feedback on the use of risk assessment scale for skin adhesives in infants and young childrenThe feedback from the pediatric clinical nurses on the use of the MARSI risk assessment scale constructed by the Institute mainly includes three aspects:1 The scale entries are set in clear and detailed,and the scores are accurate,especially the basic state dimension.2 "Paste flatness" and"Method of removal" entries are ambiguous,and the hair and skin protectant items are recommended to be deleted.3 More than half of the nurses interviewed expressed their willingness to continue using the scale and looked forward to the next revision and improvement.5 ConclusionThe risk assessment scale for skin adhesives related to infants and young children constructed by this study is divided into two dimensions:basic state and local skin glue state.There are 17 items in total,and the diagnostic boundary value is 28 points.The scale has good reliability and predictability,which helps clinical nurses to screen out high-risk children with medical adhesive-related skin damage and effectively improve the quality of care.It is recommended that this scale can be used as a clinical evaluation for hospitalized children with medical sticks.A preliminary screening tool for the risk of gel-related skin damage.