Journal of Gerontological Nursing

Predicting Pressure Ulcer Sore Risk

Elizabeth A Ayello, PhD, RN, CS, CETN

Abstract

WHY

Pressure ulcers are serious problems that occur frequently in hospitalized and community-dwelling older adults, and older adults who live in nursing homes, accounting for 3% to 11% of prevalence in acute care facilities and 24% in longterm care facilities. After they occur, pressure ulcers in older adults may lead to sepsis and death. A key to prevention is early detection of at-risk patients with a valid and reliable pressure ulcer risk assessment instrument.

BEST TOOL

The Braden Scale for Predicting Pressure Ulcer Sore Risk is among the most widely used tools for predicting the development of pressure ulcers. Clinicians typically use the tool to assess six risk areas for developing pressure ulcers: sensory perception, moisture, activity, mobility, nutrition, and friction and shear. Each risk area is assigned a score ranging from 1 (highly impaired) to 3 or 4 (moderate to low impairment). All risk areas then are added, and the total overall risk, ranging from 6 to 23 is determined. Those scores at or below 16 indicate high risk, while scores 17 and above indicate moderate to no risk.

TARGET POPULATION

The Braden Scale commonly is used with medically and cognitively impaired older adults. It has been extensively used in long-term care settings but also is used in acute and community care.

VALIDITY/RELIABILITY

The ability of the Braden Scale to predict the development of pressure ulcers has been tested extensively. Specificity of scores 16 or below ranges from 83% to 100%, and of scores 17 and above ranges from 64% to 90%, supporting die predictive validity of the instrument. Its validity increases when used in conjunction with the Norton Scale to predict the development of pressure ulcers. In addition, interrater reliability between .83 and .99 is reported.

STRENGTHS AND LIMITATIONS

When used correctly and consistently, the Braden Scale will help identify the associated risk for pressure ulcers so appropriate preventive interventions may be implemented. Although the Braden Scale has been used primarily with White older adults, current research addressing the efficacy of the Braden Scale among Black and Latino populations suggests that a higher risk cut-off score of 17 or 18 is needed to prevent underprediction of pressure ulcer risk in these populations.

MORE ON THE TOPIC

Bergstrom, N., Braden, B., Kemp, M., Champagne, M., & Ruby, E. (1996). Multi-site study of incidence ?? pressure ulcers and the relationship between risk level, demographic characteristics, diagnoses, and prescription of preventive interventions. Journal of the American Geriatrics Society, 44, 22-30.

Braden, B.J. (1997). Risk assessment in pressure ulcer prevention. In D. Krasner Sc D. Kane (Eds.)> Chronic wound care: A clinical source book for healthcare professionals (2nd ed.). Wayne, PA: Health Management Publication.

Lyder, C.H., Yu, C, Stevenson, D., Mangat, R., Empleo-Frazier, O., Emriing, J., & McKay, J. (1998). Validating the Braden Scale for the prediction of pressure ulcer risk in Blacks and Latino/Hispanic elders: A pilot study. Ostomy/Wound Management, 44(ih), Suppl., 42S-50S.

United States Department of Health and Human Services. (1992). Pressure ulcers in adults: Prediction and prevention (AHCPR Publication No. 92-0047). Rockville, MD: Author.

INSTRUMENT

The following tool represents an effective quantitative method to gather information on pressure ulcer risk in older adults. We invite nurses to duplicate the tool and encourage staff to carry it for reference.…

WHY

Pressure ulcers are serious problems that occur frequently in hospitalized and community-dwelling older adults, and older adults who live in nursing homes, accounting for 3% to 11% of prevalence in acute care facilities and 24% in longterm care facilities. After they occur, pressure ulcers in older adults may lead to sepsis and death. A key to prevention is early detection of at-risk patients with a valid and reliable pressure ulcer risk assessment instrument.

BEST TOOL

The Braden Scale for Predicting Pressure Ulcer Sore Risk is among the most widely used tools for predicting the development of pressure ulcers. Clinicians typically use the tool to assess six risk areas for developing pressure ulcers: sensory perception, moisture, activity, mobility, nutrition, and friction and shear. Each risk area is assigned a score ranging from 1 (highly impaired) to 3 or 4 (moderate to low impairment). All risk areas then are added, and the total overall risk, ranging from 6 to 23 is determined. Those scores at or below 16 indicate high risk, while scores 17 and above indicate moderate to no risk.

TARGET POPULATION

The Braden Scale commonly is used with medically and cognitively impaired older adults. It has been extensively used in long-term care settings but also is used in acute and community care.

VALIDITY/RELIABILITY

The ability of the Braden Scale to predict the development of pressure ulcers has been tested extensively. Specificity of scores 16 or below ranges from 83% to 100%, and of scores 17 and above ranges from 64% to 90%, supporting die predictive validity of the instrument. Its validity increases when used in conjunction with the Norton Scale to predict the development of pressure ulcers. In addition, interrater reliability between .83 and .99 is reported.

STRENGTHS AND LIMITATIONS

When used correctly and consistently, the Braden Scale will help identify the associated risk for pressure ulcers so appropriate preventive interventions may be implemented. Although the Braden Scale has been used primarily with White older adults, current research addressing the efficacy of the Braden Scale among Black and Latino populations suggests that a higher risk cut-off score of 17 or 18 is needed to prevent underprediction of pressure ulcer risk in these populations.

MORE ON THE TOPIC

Bergstrom, N., Braden, B., Kemp, M., Champagne, M., & Ruby, E. (1996). Multi-site study of incidence ?? pressure ulcers and the relationship between risk level, demographic characteristics, diagnoses, and prescription of preventive interventions. Journal of the American Geriatrics Society, 44, 22-30.

Braden, B.J. (1997). Risk assessment in pressure ulcer prevention. In D. Krasner Sc D. Kane (Eds.)> Chronic wound care: A clinical source book for healthcare professionals (2nd ed.). Wayne, PA: Health Management Publication.

Lyder, C.H., Yu, C, Stevenson, D., Mangat, R., Empleo-Frazier, O., Emriing, J., & McKay, J. (1998). Validating the Braden Scale for the prediction of pressure ulcer risk in Blacks and Latino/Hispanic elders: A pilot study. Ostomy/Wound Management, 44(ih), Suppl., 42S-50S.

United States Department of Health and Human Services. (1992). Pressure ulcers in adults: Prediction and prevention (AHCPR Publication No. 92-0047). Rockville, MD: Author.

INSTRUMENT

The following tool represents an effective quantitative method to gather information on pressure ulcer risk in older adults. We invite nurses to duplicate the tool and encourage staff to carry it for reference.

BRADEN SCALE FOR PREDICTING PRESSURE ULCER SORE RISK

BRADEN SCALE FOR PREDICTING PRESSURE ULCER SORE RISK

BRADEN SCALE FOR PREDICTING PRESSURE ULCER SORE RISK

BRADEN SCALE FOR PREDICTING PRESSURE ULCER SORE RISK

10.3928/0098-9134-19991001-07

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