Braden Sub-Scores Triggering Pressure Intervention Risks in the Electronic Health Record (EHR)

Purpose:

Pressure injuries are among the most common hospital acquired conditions, with approximately 2.5 million hospital acquired pressure injuries (HAPIs) occurring each year in the acute hospital setting. Use of a pressure injury risk assessment scale, such as the Braden, have proven reliable in identifying patients at risk of acquiring a pressure injury. Despite familiarity and wide application of the Braden scale, our 7-hospital system continues to have a high incidence of pressure injuries in both the adult medical/surgical and intensive care units. Healthcare professionals have depended on the Braden total scores to determine risk; however, recently, there has been increased focus on the Braden sub-scores in predicting pressure injury risk. Responding independently to Braden sub-scores has proven to help nurses identify and implement appropriate interventions to mitigate pressure injuries.

Objective:

To demonstrate the use of Braden sub-scores compared to overall score to reliably identify adults at risk of developing pressure injuries during their inpatient hospitalization and trigger appropriate interventions. Patients who are considered “at risk” in each of the 6 sub-scales of the Braden scoring tool will require nursing to implement evidence based interventions to prevent pressure injuries. Required documentation in the EHR will require the nurse to select interventions for any sub-score of 1 or 2. These selections populate the daily care flowsheet, enhancing workflow.

Outcomes:

Utilization of the Braden sub-scores in the adult inpatient population has been a work in progress. Data are pending for HAPI influence.  Nurses report satisfaction in work flow and prompting for care interventions for high risk patients.  Triggering appropriate interventions based on areas of greatest risk has proven so successful, the pediatric units will be implementing this sub score documentation for Braden Q.