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New Gap Analysis – Full Clinical Summary

New gap analysis for PI prevention & management

New Gap Analysis – Full Clinical Summary

Title: Pressure Injury Prevention and Management- A Gap Analysis Using Key Stakeholder Engagement

Date: October 2022 in Journal of Wound Ostomy Continence Nursing

Authors: Joyce Pittman, Jo Ann Otts, Bettina Riley, Madhuri S. Mulekar

Study Type: Participatory Action Research – Behavioral Science

Aim: To examine pressure injury prevention and management (PIPM) practices in an academic acute care setting. Specific aims were to (1) develop and examine key stakeholder engagement regarding PIPM practices, (2) develop a valid/reliable gap analysis instrument, and (3) conduct a gap analysis of current PIPM practices.



  • PCORI Stakeholder Engagement in QuEstion Development (SEED) and Prioritization method was used to develop stakeholder priorities, research question development, and review.
  • A 27-member task force/council completed an integrative literature search and appraisal using the 2019 International Pressure Ulcer/Injury Clinical Practice Guideline (CPG) evidence as a foundation.
  • Literature searches, content validation surveys, nursing expert’ interviews, web-based surveys and expert consensus statements were included in critically analyzing available literature.
  • Priority rating of each gap item was conducted using a Likert scale:
    • 1 = item is not a priority for action,
    • 2 = item is a fair priority for action,
    • 3 = item is a priority for action, and,
    • 4 = item is a top priority for action.
  • Content Validity Index and priority ratings were provided by N=8 nursing experts: o a chief nurse executive from a large Magnet-accredited academic healthcare system,
    • 3 WOC expert nurses,
    • a certified advanced practice WOC nurse and educator, and,
    • 3 doctoral-prepared nurse researchers.
    • content validity index (CVI) and priority ratings were analyzed to develop a standard pressure injury prevention gap analysis instrument (PIPGAI).

Note: Item-CVIs of 0.78 or higher indicate excellent content validity, a measure of how relevant the consensus statement is to the given question or topic of interest.

Results and Key Findings

  • SEM as part of quality technologies for PI prevention was rated 3 or 4 by all 8 experts with an I-CVI of 1.0 (high rating)
  • SEM was included as a key technology for routine skin assessment, with 6/8 experts rating 3 or 4 and 2/8 experts rating 1 or 2. The I-CVI was 0.75
  • SEM was included as a key adjunctive technology for darkly pigmented skin; 7/8 rated as 3 or 4 and 1/8 rated as 1 or 2; I-CVI =0.875.
  • In the evidence-based standards of care domain:
    • SEM was included as part of the priority for action in PIP gaps in quality equipment and technology for patients.
    • This domain for quality standards and technology, including SEM received the highest rating with a mean priority rating of 3.5/4 among all stakeholders (N=14)
    • SEM was included for darkly pigmented skin with a mean priority rating of 3.0/4
    • SEM was included for routine skin assessments with a mean rating of 2.6/4
    • SEM was included or technology interfacing with HER with a mean rating of 2.6/4
  • A pressure injury prevention gap analysis instrument (PIPGAI) was developed and validated.
  • SEM was included in this PIGAI tool as best practice and standards of care in two domains; EHR standardized tools for routine skin assessments and quality technology available for patients and staff for PIP.

What Does This Mean?

  • A gap analysis tool was developed and validated by a nursing expert panel for use by healthcare organizations to
  • identify gaps in PI/U prevention practices,
  • to enable healthcare facilities to minimize hospital-acquired PI/Us, and,
  • to improve patient safety and care.

SEM is being considered a key technology in pressure injury prevention practices.

SEM is included as a key technology in the highest priority rating evidence-based practice; quality equipment and technology available for patients and staff.

Inclusion of SEM in a validated PIP gap analysis tool as a quality technology, for routine skin assessments, for darkly pigmented skin and for EHR standardization is supported by a high evidence-based rating and a high priority rating.


Reference: Pittman, J., Otts, J.A., Riley, B. and Mulekar, M.S., 2022. Pressure Injury Prevention and Management: A Gap Analysis Using Key Stakeholder Engagement. Journal of Wound, Ostomy and Continence Nursing, 49(5), pp.416-427.