Patient Safety Tool Box: The Braden Scale for Assessing Pressure Ulcer Risk

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ressure ulcers cause suffering to patients. A pressure ulcer is a break down of the skin caused by unrelieved

pressure resulting in damage of the underlying tissue.1 They affect patients’ quality of life, mobility, nutritional intake, elimination, and psychological well-being, with older patients and those who suffer from chronic illness at particular risk.1

National Patient Safety Goal (NPSG) Requirement NPSG.14.01.01 requires organizations to assess and periodically reassess each patient’s and resident’s risk for

developing a pressure ulcer and take action to address any identified risks. (See “Related Requirements” on page 6 for the complete requirement.) The third element of performance requires organizations to perform a risk assessment for pressure ulcers using a validated risk assessment tool.

An example of such a tool is the Braden Scale (see Figure 1, below), although other effective scales exist, such as the

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Figure 1. Braden Scale for Predicting Pressure Sore Risk

Braden Scale for Predicting Pressure Sore Risk. Copyright: Barbara Braden and Nancy Bergstrom, 1988. Reprinted with permission. All rights reserved.

Patient Safety Tool Box

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Norton Scale. The Braden currently is the most commonly used in US health care organizations, and has the strongest evidence supporting its effectiveness.1

Health care providers can use the Braden scale to evaluate the patient’s skin integrity and to provide a comparison of preoperative and postoperative skin status. This scale can help staff determine preoperatively whether the patient is at high risk for pressure ulcer development,

diverse ethnic groups.1 Health care organizations have seen sharp declines in pressure ulcers when using the Braden Scale as part of a risk-assessment process along with the appropriate prevention protocols. For example, two nursing homes implemented the Braden Scale as part of a complete pressure ulcer prevention program and saw an 87% decrease in the incidence of pressure ulcers in the larger nursing home and a 76% decrease in incidence in the smaller nursing home.1 TS

and help them determine which interventions or precautions

should be used.1

The Braden scale is used for adult patients and has been used effectively in a variety of clinical settings and among

Reference

1. The Joint Commission. Pressure Ulcer Prevention Toolkit. Oak Brook, IL: Joint Commission Resources, 2012.

   
   

   

   Related Requirements

   National Patient Safety Goal 14

   Prevent health care–associated pressure ulcers (decubitus ulcers).

   
   

   NPSG.14.01.01

   Assess and periodically reassess each patient’s and resident’s risk for developing a pressure ulcer and take action to address any identified risks.

   
   

   Elements of Performance for NPSG.14.01.01

   1. Create a written plan for the identification of risk for and prevention of pressure ulcers.

   2. Perform an initial assessment at admission to identify patients and residents at risk for pressure ulcers.

   3. Conduct a systematic risk assessment for pressure

      
      

      ulcers using a validated risk assessment tool such as the Braden Scale or Norton Scale.

   4. Reassess pressure ulcer risk at intervals defined by the organization.

   5. Take action to address any identified risks to the patient or resident for pressure ulcers, including the following:

      • Preventing injury to patients and residents by maintaining and improving tissue tolerance to pressure in order to prevent injury

      • Protecting against the adverse effects of external mechanical forces

   6. Educate staff on how to identify risk for and prevent pressure ulcers.