Use of the Braden Scale for pressure ulcer risk assessment in a community hospital setting: the role of total score and individual subscale scores in triggering preventive interventions.
OBJECTIVE
To determine whether pressure ulcer preventive interventions are implemented when a total Braden Scale score reflects that the patient is at risk.


METHODS
A retrospective chart review was completed for 20 patients with confirmed hospital-acquired pressure ulcers (HAPUs).


METHODS
A convenience sample of 20 patients with HAPUs confirmed by a certified wound nurse was systematically selected from 63 charts. The study setting was a 200-bed acute care facility in the Midwestern United States.


METHODS
A retrospective review of 20 patient charts was conducted. Data collected included daily Braden Scale scores and subscale scores, along with pressure ulcer preventive intervention implementation for at-risk (cumulative Braden Scale scores ≤ 18) and not-at-risk (cumulative Braden Scale scores > 18) days. Data were collected both before and after pressure ulcer occurrence. The occurrence of preventive interventions was compared between at-risk and not-at-risk patient days.


RESULTS
Nineteen percent of not-at-risk patient days were found to have lower subscale scores, indicating a need for focused preventive interventions. The day before an HAPU occurred, the mean Braden Scale score was 13.7 ± 2.8 (mean ± SD) for those who were provided an intervention and 18.5 ± 2.3 for those not provided an intervention (t = 3.89, P = .001). Sixty-three percent of at-risk patients received some intervention the day before an HAPU occurred, while 20% of not-at-risk patients received some intervention.


CONCLUSIONS
Routine use of a pressure ulcer risk assessment tool is considered necessary for a comprehensive pressure ulcer prevention program. Planning preventive care according to the subscale scores of the Braden Scale may be more effective for prevention of HAPUs in some cases.
Molly M. Gadd, DNP, ACNP-BC, CWOCN, RN, St Elizabeth Healthcare, Fort Thomas, Kentucky. Sarah M. Morris, MS, Assistant Professor Research Coordinator, School of Safety, Security & Emergency Management, Eastern Kentucky University, Richmond, Kentucky.
Molly M
MM
Gadd
Sarah M
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Morris
D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D015146:Midwestern United States; D009730:Nursing Assessment / Q000379:methods*; D011187:Posture; D003668:Pressure Ulcer / Q000451:nursing / Q000517:prevention & control*; D011322:Primary Prevention / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D017592:Skin Care / Q000379:methods / Q000451:nursing*