The Relationship between the BradenRisk Assessment Scale and the Rothman Index in Hospitalized Adults

RELATIONSHIP BETWEEN THE BRADEN RISK ASSESSMENT SCALE AND THE ROTHMAN INDEX IN HOSPITALIZED ADULTS

Background & Significance:Pressure ulcer prevention is a quality measure for hospitals and a fiscal priority due to reimbursement changes. Hospitals currently use the Braden Risk Assessment Scale (BRAS) for pressure ulcer risk identification; however, use of a real time Clinical Decision Support System (CDSS) tool, such as the Rothman Index (RI), could enhance risk identification for pressure ulcer development. At present, no such system has been tested in general medical-surgical hospitalized patients.

Purpose:This project assessed the relationship between the BRAS and RI, a real time modified early warning CDSS, in adult medical-surgical patients using data from the electronic medical record (EMR).

Methods:BRAS and RI scores were obtained from the EMR of adults discharged from medical and surgical units in a rural Midwestern hospital between January 2012 and August 2013. Data were analyzed using descriptive and correlational statistics.

Results: A total of 8,750 EMRs were analyzed; 8,235 had completed data. Mean patient age was 65 years (range 18-88). Average BRAS and RI scores at discharge were 18.7 (SD± 3.0) and 71.0 (SD±17), respectively. There was a moderately strong positive relationship between the BRAS and RI at discharge (r_s=0.57, p = 0.01). 

Conclusions: These data suggest that use of a real time CDSS tool such as the RI may assist with the WOC nurse with pressure ulcer risk identification, and potentially, foster earlier pressure ulcer intervention strategies. Additional research is needed to concurrently compare the predictive validity of the BRAS and RI for assessing risk of pressure ulcer development