Braden: What's in a Number

Background: The Braden Scale for Predicting Pressure Sore Risk© has been widely used and vetted as a valid and reliable tool for two decades. Bergstrom highlights several barriers to accurately scoring patients in clinical practice including nurses’ lack of training and competency¹. Another challenge is to appropriately implement prevention interventions specific to patient risk. Creehan and Brindle developed a Stoplight illustration to visually connect risk to intervention². In our 394-bed acute care, Magnet accredited teaching hospital, chart reviews of patients who developed pressure injuries uncovered variability in scoring, that was further validated by our Wound Champion team during quarterly Prevalence Surveying. The WOC Nurse team aimed to improve accuracy and educate to prevention interventions specific to risk.

Methods: A three-part online education module was developed: 1) pre-test case study to evaluate baseline scoring accuracy; 2) learning module reviews the case study and emphasizes how sub-category scores drive prevention plan of care unique to patient risk. Interventions congruent with hospital policies, evidence-based practice and products are discussed; 3) comparison case study post-test. Additionally, a questionnaire measured staff members’ confidence and current clinical practices.

Outcomes: The module was completed by 365 RNs from eleven units. Sub-scores improved in Sensory Perception, Moisture and Activity. Total scores remained the same. Intervention scoring improved. Nurses’ perception of Braden Scale as very important increased to 83% from 77%. Over 95% of learners answered they Agree or Strongly Agree the module enhanced understanding. Learners were asked to list practice changes they would make as a result. Nurses most commonly listed “accurate assessment and appropriate interventions,” “more diligent turning,” and “keeping low head of bed.” Nurses frequently answered there were “No” barriers to implementation, others identified “time management,” “staffing,” and “contraindications.” The Wound Champion Team audits quarterly and we hope to appreciate decreased variability in scores.