Braden Scale Risk Assessment

The research studies by Bergstrom et al. (1998), Schoonhoven et al. (2002), and VandenBosch et al. (2002) came to similar conclusions in regards to the effectiveness of the Braden Scale in predicting pressure ulcer development in hospitalized patients. Even though the studies found the Braden Scale to be effective, the studies also conclusively suggested, however, that the Braden Scale alone is not sufficient enough to predict at risk patients. Each study, in its own manner, suggested that factors such as the timing of Braden Scale initiation, preventative measures, a consistent and thorough skin assessment, patient clinical status, and inter-rater reliability in staging lesions are discriminatory factors that can all impact the development

The Braden Scale demonstrated both sensitivity and specificity in risk assessment of pressure ulcer development (VandenBosch et al., 1996). In order to maximize the intervention, it is important that nursing personnel are thorough in skin assessment evaluation and can accurately identify and stage lesions. For future research, it is recommended that a consistent cut-off value be continually updated to determine at risk-hospitalized patients. As previously discussed, a current cut-off value of 18 is used which places patients in a mild risk category of the Braden Scale (Braden & Makleburst, 2005). In this health care practice area, the RN cannot overlook physical assessment. It is recommended that all future research include a proper skin assessment in accordance with hospital policy and procedure. While evidence shows that the Braden Scale is an effective risk assessment tool, it should not stand in for traditional nursing assessment, but rather be used as a tool to help determine at risk patients that are may be in need for further intervention. It is a recommendation that future research study also discuss surgical procedures in relation to the Braden Scale and possible pressure ulcer development. According to Schoonhoven et al. (2002), surgery is considered a risk factor

Hospital acquired conditions, such as pressure ulcers, may result in increased hospital stays, increased cost and time management, and other put the patient at risk for other infections. By using a risk assessment scale for skin breakdown, such as the Braden Scale, the RN can initiate preventative measures early and maybe decrease the chance of a patient developing a pressure ulcer. In line with the evidence, the Braden Scale assessment tool should be combined with thorough skin assessment and early initiation of risk assessment screening to maximize the effectiveness of the intervention. Evidence suggests that early initiation of the Braden Scale, within 48 hours of admission, and thorough skin assessment by the RN can not only maximize intervention, but also increase specificity and sensitivity of the Braden Scale. An appropriate Braden Score cut-off value for at risk patients was presented in the studies to be between 17 and 18. The current suggested cut-off value for at risk patients is 18. Hospitals and health care settings use evidence to determine an appropriate cut-off value for their institution. The cut-off value helps determine at risk patients that need further intervention to prevent pressure ulcer development. While there are still some areas for improvement with the Braden Scale as an intervention risk assessment tool for pressure ulcer development, it is still a widely used