Peering beneath the surface: an audit study of nurses’ assessment of deep tissue injuries in hospitalised patients

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Abstract Aims To evaluate the accuracy of ward nurses’ assessments of DTIs compared to assessment by Wound, Ostomy and Continence (WOC) nurses. Methodology This was a cross-sectional study conducted between Aug 2022 to Oct 2023. Electronic wound records of patients with deep tissue pressure injuries (DTIs) were reviewed in addition to physical assessment done by wound care nurses. These wound documentations were done by ward nurses. Fitzpatrick skin tone assessment was done. Patients were reviewed within 72 hours of admission by wound care nurses. Result Among 100 patients, 149 DTIs were documented, with 71% having at least one DTI. Most DTIs occurred at the sacrum (n = 41; 27.5%) and heels (n = 36; 24.2%). WOC nurse reviews were conducted after an average of 3.52 days, including both physical reassessment and review of documentation. Only 58 of 149 DTIs (38.9%) were accurately confirmed by WOC nurses, indicating considerable variability in the identification and staging of DTIs. The remaining 91 DTIs were incorrectly classified as other pressure injury stages, different wound types, or inconsistent anatomical sites. Most patients (70%) had Fitzpatrick Type II skin tones, which range from light to dark brown. Conclusion Accurate staging and diagnosis of PIs are crucial for distinguishing them from other conditions with similar morphologic characteristics. However, the persistence of DTI misclassification highlights the need for enhanced clinical assessment skills and diagnostic accuracy. Providing nurses with comprehensive education on PIs is essential to improve their knowledge, ensure accurate classification, and facilitate appropriate treatment and management. Strengthening training efforts can help minimise misclassification and improve patient outcomes. Implications for nursing and/or health policy The high rate of DTI misclassification underscores the need for targeted education and training programs to enhance nurses’ wound assessment skills. Standardised protocols and decision-support tools should be integrated into electronic health records to improve accuracy in pressure injury classification. Health policies should emphasise ongoing competency assessments and the inclusion of wound care education in nursing curricula. Strengthening these initiatives will ensure accurate diagnosis, improve patient outcomes, and reduce the risk of inappropriate treatment due to misclassification.

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