Date of Award
8-2024
Document Type
Dissertation
Department
Nursing
Committee Chair/Advisor
Margaret Wetsel
Committee Member
Jennifer Hall
Abstract
Background: Pressure injuries are significant health issues and one of the biggest challenges organizations face on a day-to-day basis. Aside from the high cost of treatment, pressure injuries also have a great impact on patients’ lives and on the provider’s ability to render appropriate care to patients The keys to preventing the development of pressure ulcers is to identify at-risk individuals as soon as possible so that measures can be implemented.
Objective: To evaluate use of the Braden Scale© on admission and weekly for three weeks in residents admitted to a short-term rehabilitation facility for two months immediately following a practice change and for the same two-month period 1 year later.
Methods: Using the EHR, a retrospective chart audit will be conducted on residents admitted to Manna Post-Acute and assessed for pressure ulcer risk using the Braden Scale © by the Wound Care nurse over two time periods - October and November 2022 and October and November 2023. Time period 1, October and November 2022, is the two months following implementation of the practice change on September 28th, 2022. Time period 2, October and November 2023, is the same two months, one year later
Results: The mean age for all patients was 77 years (range 74 years - 81 years), 70% were female, 93% were White and 7% were Black/African American. The mean BMI for all patients was 27.86 kg/m and ranged from 23.33 kg/m to 33.01 kg/m. Of the 73 patients, 64 patients had bladder continence ratings. Of these, only 26% were continent for bladder. Sightly over 17% percent of patients were frequently incontinent, 24% were occasionally incontinent, 19% were always incontinent and 12% did not have bladder continence information recorded. Thirty-one patients (42%) were continent of bowel, with 17% frequently incontinent, 15% occasionally incontinent, 23% always incontinent and less than 1% (1 patient) did not have bowel incontinence information recorded. The four most common admitting diagnoses for all patients were Fracture/Joint Replacement (N=20), Sepsis/Infection (N=10), Encephalopathy (N=9), and Respiratory Failure (N=5). Nineteen other admitting diagnosis were noted, e.g. cerebral infarction, arthritis, cancer/neoplasm, and surgical aftercare. Only one patient was admitted with a pressure ulcer diagnosis.
There was no missing data for the four weeks of the project period in October and November 2022 and October and November 2023. The Braden Scale Total Score average was 16 for Weeks 1, 2, 3 and 4 indicating mild risk. Weekly Total Scores ranged from 12 indicating high risk to 23 indicating no risk. Wilcoxon sign-rank tests were used to test the paired difference between patients’ Braden Scale Total scores for Weeks 1 and Week 4. For these patients, their Braden Scale Total Scores were not statistically significantly different from Week 1 and Week 4 for each of the project months. Mann-Whitney U tests were used to compare differences between independent groups of patients’ Week 4 Braden Scale Total Scores for October and November 2022, and October and November 2023. For these patients, their Braden Scale Total Scores for Week 4 were not statistically significantly different from October and November for each of the project years.
Conclusions: The Braden Scale is a useful instrument to identify at risk areas for individualized patients. Having the Wound Care Nurse administer, and document Braden Scale and Subscale Scores was an effective practice, as there was no missing data in this project. By performing the Braden Scale weekly for four weeks on all new admissions in the short-term rehabilitation unit, the wound nurse is able to assess risk areas for each patient and provide continuity of care. Utilizing the Braden Scale for the duration of time that patients are admitted to the facility would provide opportunities to identify patients at risk and those who would benefit from early interventions. Engaging nursing staff at all levels with full support from nursing leadership would aid to help decrease in-house acquired pressure ulcers and aid with implementing risk prevention practices. Finally, examining Braden Scale results for patients in a rehabilitation facility or on a long-term care unit would provide data and support for the reliability and validity of the Braden Scale. Braden Scale Total Scores were essentially unchanged from Week 1 to Week 4 over the month in which patients were admitted (October and November 2022 and 2023). Also, examining Week 4 Branden Scale Total Scores for two months in the same year showed no statistically differences for scores in the same clinical setting.
Keywords: Braden scale, pressure ulcers/injuries
Recommended Citation
Simmons, Amelia, "Evaluating the Use of the Braden Scale for Predicting Pressure Sore Risk© in Residents of a Short-term Rehabilitation Facility" (2024). All Dissertations. 3659.
https://open.clemson.edu/all_dissertations/3659