Improving the Accuracy of Braden Risk Assessment

The hospital participates in the National Database of Nursing Quality Indicators Pressure Ulcer Prevalence survey. Skin Team representatives perform the survey and function as experts in pressure ulcer education and prevention for their unit. Braden scores are part of the collected survey data. Our nurses are empowered to implement pressure ulcer prevention measures for patients at risk (Braden < 18). Accurate Braden assessments are important to drive patient care and improve outcomes. The purpose of this project was to determine if there were opportunities in the accuracy of the Braden assessments performed by nurses on inpatient units.

 Patient’s Braden assessments (recorded by the primary nurse) were compared to onsite assessments performed by the Skin Team. Prior to the survey, the Skin Team’s Braden assessment skills were validated with CWOCN. 190 observations were analyzed for statistical significance. A paired samples t-test was performed to compare the mean onsite assessment and the mean documented scores. The p value was <0.001 indicating the overall difference between the two sets of means was statistically significant. Data were recoded into two groups: patients at risk (Braden < 18) and patients not at risk (Braden > 19). A chi square analysis was used to determine if there was a difference in the risk categorization according to assessment source (primary nurse versus Skin Team). Pearson’s product-moment correlation coefficient indicated there was a statistically significant difference (X²=58.67, p <0.001). The Phi scores suggests this result is in the moderate risk categorization (r= 0.56, p<0.001).

Results revealed 23% of patients assessed to be at risk per Skin Team assessment were documented in the not at risk category by the primary nurse. These patients may not have received prevention measures. Based on the results, an evidence based practice project to improve Braden accuracy will be conducted.