An academic database search was undertaken to identify programme theories associated PU-RAI use. We were looking for a range of publication types and expected to find some grey literature in the academic databases due to their content coverage. This was supplemented with a Google search.
A search strategy incorporating key words relating to risk assessment, pressure ulcers and other areas associated with risk assessment instruments including falls and frailty as well as theories and publication types (systematic review, commentary, opinion piece and editorial) (Appendix 1) was used. Five databases were searched from 1970 to May 2017 (Cochrane Database of Systematic Reviews, Ovid MEDLINE, Ovid HMIC, Ovid Embase, CINAHL EBSCOhost).
Inclusion criteria: Papers relating to RAIs which describe, review, discuss, critique, provide a theoretical framework or provide stakeholder accounts of use.
Exclusion criteria: Papers relating to RAIs as a research tool or to assess psychometric properties.
Screening: After removal of duplicates, the titles, abstracts, and key words of identified papers were screened for relevance by the primary reviewer (SC). Papers considered potentially relevant were obtained in full and reviewed to assess validity and similarity (repetition) of identified programme theories. A 10% random sample of those screened and those potentially relevant were independently screened by a second reviewer (JG). Following identification of papers including relevant theories, the primary papers i.e. those providing clear detail of the possible context and mechanisms through which the intervention/programme is intended to work, were included in the review.
An example of a clearly articulated programme theory associated with this review is detailed below: ‘staff should receive adequate training to ensure they are competent to use the pressure ulcer risk assessment tool. This is especially relevant for novice practitioners who do not have the extensive clinical judgement skills that experienced practitioners have. Therefore risk assessment tools may be especially beneficial for them, particularly when admitting patients in order to prioritise care’ . To summarise one theory that can be drawn from this is that that novice practitioners who do not have extensive clinical judgement skills (Context) may particularly benefit from PU-RAI use (Mechanism) to help them prioritise care (Outcome).
Despite the database search identifying 2790 potentially relevant papers (after removal of duplicates), only 2 were considered primary papers (Fig. 1).
Subsequent Google Search
Due to the inadequate results of the academic database search a simple Google search of ‘pressure ulcer risk assessment’ and ‘pressure ulcer risk assessment tools’ was undertaken in September 2017. As a large volume of papers were identified and limited resources were available the screening was limited to the first five pages of the Google search. This identified 71 potentially relevant papers (after removal of duplicates) with 6 additional primary papers being of relevance. Two further papers were identified from the researchers’ knowledge (Fig. 1).