How's Your Accuracy ? Scoring the Braden

Each year, more than 2.5 million people in the United States develop pressure ulcers (PUs), and an estimated 60, 000 patients die of PU related complications.  The use of a standard PU risk assessment scale has been shown to aid in the design and implementation of an individualized prevention plan.  The Braden Scale for Predicting Pressure Sore Risk is a commonly used reliable and valid scale.

An interdisciplinary Performance Improvement team was convened in April of 2014 with the task of reducing our incidence of PUs. The team felt that Braden scores were not accurate.  To validate this, patients were assessed by the WOC nurse and a chart audit was done.  Twenty eight percent of scores were found to be in a different risk category than expected. 

A team charter was created with the goal of improving the accuracy of the Braden Score by 80% within 6 months. The team used Lean Six Sigma principles to identify theories for incorrect scoring.  To validate these theories, we created a survey with two case studies enlisting a random sample of nurses (N=32) to generate a Braden score.  The survey revealed that scores were inconsistent and inaccurate, especially sensory perception, nutrition, and mobility.

There was little participation in initial education so we created Take 5 Edu-Minutes:  A new teaching plan for quick, easy education on the purpose, policy and Braden subscales that was offered several times a week over 8 weeks, with a new topic each week.  The format included objectives, definitions, key scoring points, scenarios, and “Braden bits”.

Our post intervention data collection included another random survey and assessment/chart audit.  We found that our scoring accuracy actually decreased in both areas.  Although the results were discouraging, our team will continue to move forward to establish a formal Save Our Skin Champion Program.