Understanding the Braden Scale of Measuring Pressure Ulcers

Sep 26, 2017

Nursing homes must follow strict regulations in terms of pressure ulcers – be it recognition, prevention, or treatment.  One critical component of each of these factors is understanding the Braden Scale of measuring pressure ulcers.  The Braden Scale is the most widely used assessment tool to help caregivers and healthcare providers determine risk and reduce the likelihood of a pressure ulcer developing.  Read on to learn more about the Braden Scale, how it is used, and why it is so important to assess risk properly and take action in the fight against pressure ulcers.

Understanding the Braden Scale

The Braden Scale is an assessment tool based on two primary factors of pressure ulcer development – duration of pressure and intensity of pressure.  These two factors are broken down into six subscales, which are:

  • Sensory Perception
  • Moisture
  • Activity
  • Mobility
  • Nutrition
  • Friction/Shear

These six subscales contain a numerical value, or score, that identifies the level of risk.  One is the lowest score possible.  All subscale scores range from 1-4 with the exception of friction/shear, which ranges from 1-3.  To determine risk, the patient is assessed based on each subscale and a score is determined.  The lower the score is, the higher risk of developing a pressure ulcer.  This score is then used to develop preventative strategies.

When using the Braden Scale, it is important to remember that each individual and individual situation varies.  This scale offers a broad context for assessing risk and implementing preventative protocols.  Specific preventative protocols and interventions should be developed based on the needs of the patient, and the resources available to the caregiver or healthcare provider.

In the broad context, the Braden Scale and recommended preventative protocols resembles the following:

  • 15-18 Points: At Risk – Preventative protocols include frequent turning, maximizing mobilization, protecting the patients skin (specifically heels), ensuring proper support surfaces for immobile patients, and managing nutrition, moisture, and friction/shear.
  • 13-14 Points: Moderate Risk – Preventative protocols include frequent turning, maximizing mobilization, protecting skin surfaces, providing foam wedges for lateral support (30 degrees), and managing elements of nutrition, moisture, and friction/shear.
  • 10-12 Points: High Risk – Preventative protocols include increased frequency of turning, supplementary turning with slight shifts in positioning, maximal remobilization, protecting skin surfaces, providing foam wedges for support, and managing moisture, nutrition, and friction/shear.
  • 9 Points or Less: Very High Risk – Protocols may include measures from previous category (high risk), as well as the addition of pressure-relieving surfaces if the patient:
    • Has “intractable” pain
    • Has pain made worse by turning
    • Has risk factors like malnutrition or immobility

Depending on the patient’s overall health, age, comorbid factors, blood pressure, and nutritional needs, he or she may be advanced to a higher risk category without the six subscales identifying that level of risk.

Improper Braden Scale Assessments

One of the most important tools for successful prevention and treatment of pressure ulcers is proper use and interpretation of the Braden Scale.  Research consistently shows that the reliability of Braden Scale assessments often depends on the healthcare provider’s understanding of risk factors and ability to factor those risks into the overall risk assessment.  To get a proper understanding of the patient’s overall health and needs, the healthcare provider should conduct a full body physical examination including:

  • Focus on health of skin (pressure points, coloration, pain, bogginess, etc.)
  • Examine the patient for signs of edema, heart disease, or peripheral vascular disease
  • Assess the patient for signs of obesity or related disorders

One news source recently discussed a long-term care facility that was found to have conducted Braden Scale assessments at the time of admission, as well as reassessments at a later date, but patient outcomes were not consistent with risk assessment.  It was discovered that most residents who had pressure ulcers had previously been assessed at low- or no-risk of developing pressure ulcers.

The issue in this example was that the licensed or registered nurses conducting the Braden Scale assessments had not adequately identified comorbid risk factors like diabetes.  Without this identification, appropriate interventions were not used to reduce the risk of developing pressure ulcers.

Pressure Ulcer Assessment and Your Legal Rights

Nursing homes and healthcare facilities are required to provide every patient/resident with quality care.  Care plans must be managed in a way that supports the individual’s health and wellbeing.  Failing to properly use the Braden Scale assessment and recognize pressure ulcer risk does not support the individual’s health and wellbeing.  In fact, it is often considered a form of neglect or negligence.

When pressure ulcer risk is not properly assessed, or when developing pressure ulcers do not get appropriate intervention, the results can be catastrophic.  Small wounds can quickly enlarge, spread to deeper tissue, or become infected.  Once a pressure ulcer has presented an open wound or deep tissue damage, the patient is vulnerable to serious complications or death.

If you are concerned that your loved one has not been properly assessed for pressure ulcer risk, and he or she has been diagnosed with pressure ulcers, contact Brown & Brothers today to learn more about protecting their legal rights.  Even in the best nursing homes and healthcare facilities, pressure ulcers sometimes occur.  What is most important is that caregivers and healthcare providers know how to quickly respond to risks or signs of a pressure ulcer.  In many cases, quick intervention and medical treatment can reduce the chances for a life-altering or fatal complication.

To learn more about pressure ulcer assessments, the Braden Scale, or nursing home or healthcare neglect, fill out our online form to schedule your free case evaluation.