Examining the Impact of the 6 Subscales of the Braden Risk Assessment Tool

Abstract

Background

Regardless of national guidelines on preventing pressure ulcers, the risk assessment tools and policies in place in certain organizations, and the accessibility to pressure ulcer prevention evidence based interventions and information via the web, these debilitating wounds still occur.² In many institutions, RNs are expected to carry out a Braden risk assessment for each patient daily along with their comprehensive assessment,³ and yet HAPU continue to occur nationally.  There is an implied poor relationship between protocols already in place and prevalence and incidence rates in practice.⁴ The Purpose of the Braden Scale for Predicting Pressure Sore Risk (BS) is to precisely predict the patients who might develop a pressure ulcer, and for the planning of successful preventive interventions according to the risk factors scores of the individual Braden subscales.³

Methods

The retrospective chart audit study included 20 medical records covering 322 patient days.  Data was collected focusing on the daily BS total and subscale scores, and the preventive interventions implemented on each day.

Results

When the data frequencies were analyzed there were 61 days covering 14 medical records where the BS was 19 or greater indicating “not-at-risk”.   For this group, preventive interventions were only implemented 12.5% of the time even though there were 143 (n=143) subscales that had suboptimal scores.   Eventually all 14 of the patients developed a hospital acquired pressure ulcer. 

Conclusion

The author believes that there should be more emphasis on the Braden subscales directing preventive interventions versus the total Braden Score.  Rather than the BS serving as a screening tool that adds one more step to patient care, the BS use could be enhanced through clinical decision support systems in an electronic medical record that would pull together the nursing process, allow for timely care, and accurate documentation.