Enhancing the Braden Scale Pressure Ulcer Risk Assessment in Long-Term Care Facilities: A Cohort Study
Date of Award
Doctor of Nursing Practice (DNP)
Shannon Simonovich, PhD, RN
Christina Lattner, DNP
Joseph Tariman, PhD, ANP-BC, FAAN
The development of pressure ulcers remains challenging as they are associated with overwhelming costs, pain and suffering, prolonged hospitalization, and morbidity and mortality. In the United States, the Braden scale is the most widely used risk assessment tool among all healthcare organizations to identify high-risk individuals for pressure ulcer development. The objective of risk assessment is to detect high-risk patients, implement immediate interventions, and evaluate patients not at risk who do not require intervention. The purpose of this cohort study is to determine the pressure ulcer predictability of the Braden score in comparison to the Braden score with additional predictor factors. Predictor factors explored in this research incorporate those described in current literature as pressure ulcer risk factors: age, gender, comorbidities, and history of previous pressure ulcer. This study utilized an observational cohort research design to appraise the effectiveness of an intervention based on evidence and data. Logistic regression statistical analysis was applied to establish how successful Braden total scores were in a pressure ulcer predictive model with and without the addition of additional predictor factors. A separate relative risk model was tested using only the most applicable predictor factors correlated with pressure ulcer prevalence in this model without the Braden score in an effort to cultivate the most relative model. The research was conducted solely at Symphony of Lincoln Park in Chicago, Illinois. All patient records from January 2020 through July 2020 were reviewed and identified to attain data recorded on the data collection sheet of patients who developed pressure ulcers during that time frame along with the same number of patients who did not develop pressure ulcers but were classified as at-risk as evidenced by a Braden score of 18 or less, resulting in a total of 119 adult long-term care residents. The general assumption from this analysis was that a logistic regression model of pressure ulcer development in long-term care residents indicated 9 predictors able to determine a statistically significant risk of pressure ulcer development. Specifically, the analysis suggested high risk Braden total scores (mean=15), history of pressure ulcer, anemia, limb paralysis, osteoporosis, malnutrition, incontinence, CHF, Alzheimer’s, and DM2 can be predictive of the development of pressure ulcers in long-term care residents. The analysis integrated a predictive model using binary logistic regression, which revealed that the Braden total score alone was accurately able to predict 75.6% (76.6% subjects that did develop pressure ulcers were accurately predicted and 74.5% of subjects which did not develop pressure ulcers were accurately predicted in the Braden score only model). Adding the presence of history of pressure ulcer, anemia, limb paralysis, osteoporosis, malnutrition, incontinence, CHF, Alzheimer’s, and DM2 was able to accurately predict 98.3% (96.9% with PU, 100% without PU). More research is needed to substantiate these findings and investigate contemporary risk assessment methods, with the ultimate objective of reducing the incidence of pressure ulcers.
Deutsch, Rachel, "Enhancing the Braden Scale Pressure Ulcer Risk Assessment in Long-Term Care Facilities: A Cohort Study" (2021). College of Science and Health Theses and Dissertations. 450.