Tool and Resource Evaluation Template

Adapted by NARI from an evaluation template created by Melbourne Health. Some questions may not be applicable to every tool and resource.
Name and purpose Name of the resource: Norton Risk Assessment Score Author(s) of the resource: D. Norton, R. McLaren and A.N. Exton-Smith Please state why the resource was developed and what gap it proposes to fill: This tool was designed to evaluate a patients risk of developing a pressure sore. It focuses on five distinct areas: physical condition, level of consciousness, activity, mobility and incontinence. Designed for the geriatric patient. Target audience (the tool is to be used by) Please check all that apply: Health service users Medical staff Carers Nursing staff Any member of an interdisciplinary team

Medical specialist, please specify: Specific allied health staff, please specify: Other, please specify: Target population/setting (to be used on/in) Is the resource targeted for a specific setting? Please check all that apply: Emergency Department Other, please specify: For which particular health service users would you use this resource (e.g. a person with suspected cognitive impairment)? All in-patients in acute and subacute settings, or residents in aged care facilities. Structure of tool Website Pamphlet Methodology Education package Assessment tool Resource guide Video Screening tool Awareness raising resource (posters etc.) Inpatient acute Inpatient subacute Ambulatory

Other, please specify: Please state the size of the resource (e.g. number of pages, minutes to read): 1 page, usually printed in A4 Takes less than one minute to complete once the patient is assessed. Availability and cost of tool Is the resource readily available? Is there a cost for the resource? Yes Yes No No Unknown Unknown Not applicable Not applicable

Please state how to get the resource: The Norton scale is provided below: The Norton Scale It is also readily available via intranet. Applicability to rural settings and culturally and linguistically diverse populations Is the resource suitable for use in rural health services (e.g. the necessary staff are usually available in rural settings)? Yes No Unknown Not applicable Is the resource available in different languages? Yes No Unknown Not applicable for use by staff

Is the content appropriate for different cultural groups? Yes No Unknown Not applicable

Person-centred principles Training requirements

Does the resource adhere to/promote person-centred health care? Yes No Unknown Not applicable

Is additional training necessary to use the resource? Yes No Unknown Not applicable

If applicable, please state how extensive any training is, and what resources are required:

Administration details

How long does the resource take to use?

0-5 mins

5-15 mins

15-25mins

25mins +

Can the resource be used as a standalone, or must it be used in conjunction with other tools, resources, and procedures? Standalone Must be used with other resources, please specify: Can be used with other tools, please specify: Data collection and analysis Are additional resources required to collect and analyse data from the resource? Yes No Unknown Not applicable Guidelines

If applicable, please state any special resources required (e.g. computer software): Sensitivity and specificity Sensitivity is the proportion of people that will be correctly identified by the tool. Specificity is the probability that an individual who does not have the condition being tested for will be correctly identified as negative. Has the sensitivity and specificity of the resource been reported? Yes No Unknown Not applicable If applicable, please state what has been reported: Initial testing of the tool found a linear relationship between the initial score on admission to hospital and the incidence of pressure ulcers (defined as a break in the skin surface). However, retrospective validity measures indicate poor validity with a sensitivity of 63 % and a specificity of 70%, (Bridel, 1993). In other studies, 0 100% sensitivity and 9 90% specificity have been reported (Defloor & Grypdonck, 2004). Face Validity Does the resource appear to meet the intended purpose? Yes No Unknown Not applicable Reliability is the extent to which the tools measurements remain consistent over repeated tests of the same subject under identical conditions. Inter-rater reliability measures whether independent assessors will give similar scores under similar conditions. Has the reliability of the resource been reported? Yes No Unknown Not applicable If applicable, please state what has been reported: No conclusions on the reliability could be drawn as few studies have explored this (Bridel, 1993) and reliability has not been properly assessed (Raycroft-Malone, 2000). Due to early criticism, modifications of the Norton Score have included operational definitions. This has created difficulty in interpreting the rating between subscales such as fair and poor or limited and slightly limited (Norton, 1989). Strengths What are the strengths of the resource? Is the resource easy to understand and use? Are instructions provided on how to use the resource? Is the resource visually well presented (images, colour, font type/ size)? Does the resource use older friendly terminology (where relevant), avoiding jargon? Please state any other known strengths, using dot points: User friendly. Quick. Simple evaluation. Despite criticisms and modified variations, the Norton Risk Assessment Score is still one of the most widely used assessment tools (Bridel, 1993). Limitations What are the limitations of the tool/resource? Is the tool/resource difficult to understand and use? Are instructions provided on how to use the tool/resource? Is the tool/resource poorly presented (images, colour, font type/ size)? Does the tool/resource use difficult to understand jargon? Please state any other known limitations, using dot points: Argued to be too simplistic and not valid outside the geriatric area. No data on reliability. Some risk components are unclear and difficult to understand (Papanikolaou et al., 2007). Critical cut-off score is disputable (Papanikolaou et al., 2007).

Reliability

References and further reading

Supporting references and associated reading. 1. Australian Wound Management Association Clinical Practice Guidelines for the Prediction and Prevention of Pressure Ulcers. For copy of score and guidelines see Appendix B. Available at: http://www.awma.com.au/publications/2007/cpgpppu_v_full.pdf Bridel J. Assessing the risk of pressure sores. Nursing Standard 1993: 7:162-167 Defloor T & Grypdonck M. Validation of pressure ulcer risk assessment scales: a critique. Journal of Advanced Nursing. 2004;48:613-621. Health Services Technology Assessment Test - National Library of Medicine. http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat2.chapter.4409 Norton D. Calculating the risk: reflections on the Norton Score. Decubitus 1989;2:24-31 Norton D., McLaren R, and Exton-Smith A.N. An investigation of geriatric nursing problems in the hospital. 1962. London. National Corporation for the Care of Old People (now the Centre for Policy on Ageing). Papanikolaou P, Lyne P & Anthony D. Risk assessment scales for pressure ulcers: A methodological review. International Journal of Nursing Studies, 2007;44:285-296. Raycroft-Malone J. Pressure ulcer risk assessment and prevention. Technical reporting. 2000 RCN Publishing, London.

2. 3. 4. 5. 6.

7. 8.

The Norton Scale

NOTE: Scores of 14 or less rate the patient as at risk
Physical Condition
Good Fair Poor Very bad
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Mental Condition
1 2 3 4 Alert Apathetic Confused Stupor 1 2 3 4

Activity

Mobility

Incontinence

Total Score
1 2 3 4

Ambulant Walk/help Chairbound Bedridden

1 2 3 4

Full Slightly Limited Very limited, Immobile

1 2 3 4

Not Occasional Usually-urine Doubly

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Source: Doreen Norton, Rhoda McLaren, and A.N. Exton-Smith. An Investigation of Geriatric Nursing Problems in the Hospital. London. National Corporation for the Care of Old People (now the Centre for Policy on Ageing); 1962. Adapted with permission of the publisher.