Overview :

The Knoll Assessment Tool for Pressure Ulcer Potential was developed by Abruzzese for identifying a patient's risk for pressure ulceration. The original tool was modified to include additional measures. The tool can be monitored over time to determine the change of risk associated with changes in the clinical condition of the patient.

Original Parameters:

(1) general health status

(2) mental status

(3) activity

(4) mobility

(5) incontinence

(6) predisposing disease

Additional Parameters for the modified version:

(7) nutritional intake

(8) fluid intake

plus 2 additional point categories for incontinence (4 items rather than 2).

where:

• In both papers by Aronovitch there is a table to define each parameter. One representation for the tool would be to grade each item mentioned (serum albumin, PaO2, etc.), but this would be a longer and more complex instrument.

• For example, under predisposing diseases, severe disease = uncontrolled diabetes, uncontrolled anemia, PaO2 < 60 mm Hg, shock, paralysis, immunosuppression with infection, advanced vascular disease.

• If you wish to seriously implement the instrument, then it would be necessary to include the table of definitions.

pressure ulcer potential score =

= SUM(points for all 8 parameters)

Interpretation:

• minimum score: 0

• maximum score: 33

• The higher the score, the greater the risk for developing a pressure ulcer.

• A score >= 11 indicates a person at risk for pressure ulceration (Aronovitch 1992, page 75).

• Patients with a score >= 16 should be placed on pressure relief surfaces (Aronovitch 1993, page 30).

Performance:

• Cronbach's alpha: 0.63

• interrater reliability: 0.866

Abruzzese RS. The effectiveness of an assessment tool in specifying nursing care to prevent decubitus ulcers. pages 43-60. IN: PRN: The Adelphi Report. Project for Research in Nursing. Adelphi University. 1982.

Abruzzese RS. Early assessment and prevention of pressure sores. pages 1-19. IN: Lee BY (editor). Chronic Ulcers of the Skin. McGraw-Hill Co. 1985.

Aronovitch S, Millenbach L, et al. Investigation of the Knoll assessment scale in a tertiary care facility. Decubitus. 1992; 5 (3): 70-76.

Aronovitch SA. The use of an assessment tool in managing placement on pressure relief surfaces. Ostomy/Wound Management. 1993; 39 (May): 18-32.

Towey AP, Erland SM. Validity and reliability of an assessment tool for pressure ulcer risk. Decubitus. 1988 (May); 1(2): 40-48.