Braden Scale Notes

Braden Scale for Pressure Ulcer Risk Assessment

Importance of Braden Scale

• The Braden Scale is crucial for assessing the risk of developing pressure ulcers.
• This is especially important for individuals with reduced activity and prolonged bed rest, common in spinal cord injury cases.
• These factors can lead to the development of pressure ulcers.

Use and Validation

• The Braden Scale is widely used for assessing pressure ulcer risk.
• It has been validated for use with people who have spinal cord injuries.
• Using a pressure ulcer risk tool is considered best clinical practice in preventing pressure ulcers.
• Required for full accreditation in many hospital systems.

Ongoing Assessment

• Ongoing assessment improves the accuracy and predictive ability of the Braden Scale.
• A Braden assessment should be completed:
  • Upon patient admission to the hospital.
  • When there is a change in the patient's medical status.

Administration

• The Braden assessment is simple for both the provider and the patient.
• No special equipment or activities are required.
• Information is obtained from:
  • Client interviews.
  • Observation.
  • Chart abstraction.
• Typically completed in 10 minutes.

Structure of the Braden Scale

• The Braden Scale is a 23-point instrument.
• It is composed of six subscales:

1. Sensory Perception

• Assesses the level of consciousness.
• Evaluates the patient's ability to sense and react to pain related to pressure.

2. Moisture

• Excessive and continuous skin moisture can pose a risk to the integrity of the skin.

3. Activity

• Very little or no activity can cause decreased muscle mass and tissue breakdown.

4. Mobility

• Examines the client's capability to adjust their body position independently.
• Assesses the physical ability to move.
• Considers the client's willingness to move.

5. Nutrition

• Eating only portions of meals or having imbalanced nutrition can indicate an increased risk for tissue breakdown.

6. Friction and Shear

• Friction: Affected by the amount of assistance a client needs to move and the degree of sliding on beds or chairs.
• Shear: Occurs when skin and bone move in the opposite direction of the support surface.

Scoring

• Each subscale includes three or four levels with key concept descriptions and qualifying attributes.
• Example: Activity subscale:
  • 1: Bedfast
  • 2: Chairfast
  • 3: Walks occasionally
  • 4: Walks frequently
• Alterations to the scale (adding, deleting, or modifying items) will result in inaccuracies.
• One to four points are assigned for each subscale.
• These scores are combined to give a final score.
• Total scores range from 6 to 23.
  • $6 \leq \text{Total Score} \leq 23$
• A lower score indicates a higher risk of developing a pressure ulcer.
• Scores below 18 indicate that preventive measures must be taken to maintain skin integrity.
  • $\text{Total Score} < 18 \implies \text{Preventive Measures}$
• Preventive measures should always be considered, even with lower-risk individuals.

Reassessment

• Reassessment is recommended for all patients receiving scores of 18 or less.
• Frequency of reassessment:
  • Acute settings: Every 24 hours or as the patient's condition changes.
  • Long-term care: Weekly for four weeks, then quarterly or as the resident's condition changes.
  • Home care and community clients: Quarterly or with each caregiver visit.

Actionable Recommendations

• Risk assessment is ineffective if no action is taken when at-risk individuals are identified.
• Action recommendations can help direct practice with each Braden subscale.
• These recommendations guide clinicians in specific preventive measures.
• Examples of best practice prevention:
  • Inspection of skin.
  • Pressure relief.
  • Appropriate seating equipment.

Communication and Resources

• The Braden Scale is widely used and understood across many healthcare disciplines, allowing common communication between practitioners.
• Resources:
  • Braden risk assessment and interventions flow sheet.
  • Braden website (video, CD, and case studies) for further details on scoring and using the scale in clinical practice.