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

PURPOSE: To determine whether pressure ulcer preventive interventions are implemented when a total Braden Scale score reflects that the patient is at risk. DESIGN: A retrospective chart review was completed for 20 patients with confirmed hospital-acquired pressure ulcers (HAPUs). SUBJECTS AND SETTING: 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.