Accuracy of nurses' Caprini risk assessment for venous thromboembolism: a simulation-based observational study in China.

BACKGROUND

Accurate venous thromboembolism (VTE) risk assessment using the Caprini Risk Score (CRS) is crucial for identifying high-risk patients and initiating preventive measures. While nurses are the primary assessors in many clinical settings, the complexity of the CRS poses significant challenges to implementation. Limited evidence exists regarding the actual precision of nurses’ scoring and the specific sources of error, which can directly compromise patient safety. This study aimed to evaluate nurses’ accuracy in applying the CRS and to identify factors and item domains associated with scoring errors.

METHODS

This observational, single-center descriptive study was conducted in 2023 across eight inpatient wards at a tertiary hospital in Southwest China. A total of 213 nurses from internal medicine (including infectious diseases, rheumatology and immunology, communicable diseases, pain management, respiratory medicine, and comprehensive respiratory care) and surgical departments (thoracic surgery and ICU) performed CRS evaluations using standardized simulated cases.

RESULTS

Among the 213 participants, only 45 (21.13%) achieved full scoring accuracy. Chi-square tests revealed significant differences (P < 0.05) in accuracy based on experience, professional titles, and departments. Nurses with ≤ 5 years of experience showed the lowest accuracy (5.32%), while those with junior titles achieved 13.74%. Accuracy differed across departments, with rheumatology/immunology and the ICU showing lower accuracy than other wards (P < 0.05). Accuracy rates for key item domains - functional status, past medical history, and other high-risk factors were 43.66%, 40.85%, and 43.19%, respectively.

CONCLUSIONS

Nurses with ≤ 5 years of experience and junior titles require targeted VTE assessment training. Overall low accuracy indicates a risk of misclassification that may affect thromboprophylaxis decision-making. Enhanced training and clearer, culturally appropriate wording of the CRS translation, particularly for commonly confused items, are needed. Nursing managers should implement competency-focused training and quality monitoring to improve the reliability of CRS-based risk assessment. CLINICAL TRIAL NUMBER: Not applicable.