OR Manager - September 2018 - 18
Munro Scale research supports streamlining risk levels
Patient safety
he Munro Pressure Ulcer Risk
Assessment Scale for Perioperative
Patients © (Munro Scale) has
made great strides in the past year. The
tool, which assesses patients' risk levels
at each phase of surgery (preoperative,
intraoperative, and postoperative),
is available from AORN.
T
Cassendra Munro, MSN, RN, CNOR,
developed the Munro Scale and is researching
ways to refine the tool. Recent
results and next steps are presented
in this article.
Recent endorsements
Cassendra
Munro, MSN,
RN, CNOR
The Joint Commission
Compliance Strategies
published in the November
2017 issue of The
SourceTM recommended
implementation of the
Munro Scale as a standardized
process for
early identification of
perioperative patients at
risk for pressure injuries.
AORN's Guideline for Positioning
the Patient has recommended use of
the Munro Scale since 2016, and the
Munro Scale is available in the AORN
Prevention of Perioperative Pressure
Injury Toolkit. The Munro Scale and the
mnemonic, CMUNRO SCALE, also are
available in the OR Manager Toolbox at
www.ormanager.com.
AORN also has made the Munro
Scale available for use via the AORN
Mobile app, where it is listed as the
" Munro Calculator. "
Providence St. Joseph Health's
Southern California Region is proposing
building the Munro Scale into Epic, and
there are ongoing discussions for systemwide
dissemination, which would include
50 hospitals nationwide. The only
other electronic health record in which
the Munro Scale has been implemented
is AORN's Syntegrity.
Simulation modeling study
A big step forward for the Munro Scale
was a simulation modeling study to
test the psychometric properties of the
Munro Scale. Results indicated that
the Munro Scale can perform well using
a two-level outcome rather than three
levels.
" The clinical implications are significant
given the question of how to treat
a patient with a medium level of risk, "
Munro told OR Manager. She will do
a follow-up study with a larger number
before making a change to the Munro
Scale.
Currently, each phase of the Munro
Scale assessment results in a risk
score of low, medium, or high, with a
cumulative score at the end that is documented
and communicated to the inpatient
unit nurse for continuation of care.
The idea for the simulation study
came after validation studies for the
Munro Scale showed the majority of
scores were in the high-risk level, and
middle-risk level outcomes were not
well demonstrated when the Munro
Scale was tested on a sample of 299
patients at a single site.
Munro and nurse researcher Kathleen
Russell-Babin, PhD, RN, NEA-BC,
ACNS-BC, corporate director, nursing
education and quality, Hackensack Meridian
Health, New Jersey, performed a
study using simulation techniques to:
* provide additional input on the risk
levels
* strengthen the psychometric properties
of the Munro Scale
* create a more predictive model.
" We wanted to answer the questions:
'How would the Munro Scale
perform if we changed it to a two-level
risk?' and 'How would the Munro Scale
perform with adjusted thresholds for the
risk levels?' " says Munro.
She points out that it is possible to
maintain a three-level risk scale, but
there are clinical implications for why a
two-level risk may be more feasible than
three. For example, Munro says, the
Braden Scale for Predicting Pressure
Sore Risk (http://www.bradenscale.
com/images/bradenscale.pdf) has several
levels of risk, but only has a slight
variation in the care for each level. " You
Model Settings
Patient Sampling Approach
Risk level
Simulation sample size
Risk level threshold for risk
counting model
Low to High*
Sample real patients
2-level outcome
1000
Pre-Op
9
*Value in table is minimum value for the higher risk level
Intra-Op
23
Post-Op
27
Create simulated patients
3-level outcome
Used with permission, Cassendra Munro, MSN, RN, CNOR.
18
OR Manager | September 2018
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OR Manager - September 2018
Table of Contents for the Digital Edition of OR Manager - September 2018
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