Predicting Pressure Ulcer Risk Research Articles

Selected Biochemical Blood Parameters and a Risk of Pressure Ulcers in Patients Receiving Treatment in Intensive Care Units.

Background and Objectives: This study aimed to assess the level of selected biochemical parameters in venous blood and their potential effects on the development of pressure ulcers in patients treated in intensive care settings. Materials and Methods: Fifty patients hospitalised in an intensive care unit (ICU) were enrolled for the study. The methods used included controlled observation, literature review and medical record analysis. The observation protocol applied in the study consisted of two parts comprising the basic information, sociodemographic data, results of laboratory tests (CRP, PCT, albumin, protein and haemoglobin concentrations) as well as the Braden Scale for Predicting Pressure Ulcer Risk. Results: The subjects presented moderate to high risk of pressure ulcers, reflected by the mean score of 8.18 ± 1.3 points, with minimum and maximum scores of 6 and 12 points, respectively. Normal albumin level was identified in only five subjects (10.0%) while 45 subjects (90.0%) were found with results below the norm. A statistical relationship was observed between such variables as albumin concentration (p < 0.01) and total protein level (p = 0.007). The findings show a strong correlation between the score in the Braden Scale and the level of albumins (R = 0.55). Conclusions: In our study, lower concentrations of albumins and total proteins correspond to a greater risk of pressure ulcers.

Contribuição de um software para o registro, monitoramento e avaliação de feridas

The aim was to describe the construction of a software for recording, monitoring, and evaluating wounds. It is a technological production research containing software development. It was carried out in three stages: project management through the Scrum tool, software construction, content validation and pre-test. As a result, the app was built after reviewing the literature in databases. The management system allowed registering patients, performing the assessment, and monitoring of the evolution of the lesions through images and other tools, such as graphs of the results of the Braden Scale for Predicting Pressure Ulcer Risk and Pressure Ulcer Scale for Healing. In addition, information about coverage and treatment alternatives is available. The development of an initial prototype allowed the exploration of ideas, before investing in production, helping to save time and resources, modulating the final product to be developed according to the needs of the target audience. In conclusion, the present study demonstrated that the construction of the software meets the need for recording, monitoring, and evaluating wounds. The prospects are that it can also be used to carry out realistic simulation and training, in addition to having easy access and handling.

Testing of Braden QD Scale for predicting pressure ulcer risk in the Pediatric Intensive Care Unit.

Children admitted to the Pediatric Intensive Care Unit (PICU) are at risk for pressure injury due to immobility and the challenge of positioning medical devices. However, a comprehensive instrument to assess pressure injury risk is still finite. This study aimed to test the validity and reliability of the Braden QD Scale. The design used was a Pearson correlation coefficients and Cronbach’s alpha (α). Fifty-one pediatric patients below age 18 who had been bedridden for at least 24 hours were engaged through a consecutive sampling method. The results showed assessments made by using the Braden QD Scale revealed that 88.2% of patients were at risk for a pressure injury. The validity test results of the Braden QD Scale ranged between 0.532 and 0.833. The reliability test results of the Braden QD Scale ranged between 0.756 and 0.834. The sensitivity value is 100%, specificity value is 40%. In general, the study finding suggests that the Braden QD Scale is a valid and reliable instrument for predicting pressure injury risk. Nurses may employ this tool to assess pressure injury risk in pediatric patients.

Nonblanchable erythema for predicting pressure ulcer development: a systematic review with an individual participant data meta-analysis.

Empirical evidence is uncertain regarding the value of nonblanchable erythema in predicting the incidence of stage 2 (or more severe) pressure ulcers. To investigate whether nonblanchable erythema is an independent prognostic factor for pressure ulcer incidence using individual patient data. We performed an electronic database search in February 2017 to identify longitudinal studies that considered nonblanchable erythema for predicting pressure ulcer risk in any population. We collected individual participant data for the included studies, and assessed the risk of bias of these studies using the Quality In Prognosis Studies tool. We analysed individual participant data in Stata using mixed-effects logistic regression to investigate the association of interest. The certainty of evidence from individual participant data analysis was assessed using the Grades of Recommendation Assessment, Development and Evaluation. The study was registered with PROSPERO (CRD42017081151). From the 13 included studies (total 68077 participants) we had access to individual participant data from four (n = 3223), and 11·9% of participants (383 of 3223) developed new pressure ulcers of stage 2 or above within 28 days. Mixed-effects logistic regression showed that participants with nonblanchable erythema had higher odds of developing new pressure ulcers of stage 2 or above within 28 days of follow-up than those without nonblanchable erythema (multivariable association: n = 2684; odds ratio 2·72, 95% confidence interval 2·02-3·69; τ2 = 0; moderate-certainty evidence). This first prognostic factor review with individual-level data analysis in patients with pressure ulcers suggests that people with nonblanchable erythema are more likely to develop new pressure ulcers of stage 2 or above within 28 days than people without nonblanchable erythema. It is important to identify nonblanchable erythema in practice and to intervene appropriately to prevent pressure ulceration. What's already known about this topic? Pressure ulcer reduction is a high priority for healthcare systems. Regularly inspecting skin to identify skin abnormalities is one key practice for preventing ulceration. Nonblanchable erythema - discoloration of the skin that does not turn white when pressed - is one clinically important skin abnormality. Empirical evidence synthesized using conventional meta-analysis is uncertain regarding the value of nonblanchable erythema for predicting open pressure ulcer incidence; this is partly because the conventional technique has weakness in terms of pooling prognostic effects of different multivariable analyses across studies. What does this study add? This prognostic factor review used individual-level data analysis to overcome the limitations of the conventional meta-analysis technique. For the first time there is confirmatory and moderate-certainty evidence on the association of nonblanchable erythema with pressure ulcer incidence. People with nonblanchable erythema are more likely to develop new pressure ulcers of stage 2 or more severe within 28 days than people without nonblanchable erythema, regardless of their age, baseline pressure ulcer risk or received support surfaces.

Sequential Organ Failure Assessment (SOFA) to Predict Pressure Ulcer Risk in Intensive Care Patients: A Retrospective Cohort Study

The authors assessed the performance of the Sequential Organ Failure Assessment (SOFA) scale and its subcategories in predicting the development of PUs. A retrospective cohort study was conducted of all adult patients admitted to the mixed medical-surgical ICU of a Finnish tertiary referral hospital between January 2010 and December 2012. Data (diagnoses, demographics, clinical information, treatments, and instrument scores) were retrieved from the ICU database. Wilcoxon and chi-squared tests were used to examine patient subgroup (medical or surgical ICU and intensive care or high-dependency care patients), length of ICU stay (LOS), modified Jackson/Cubbin (mJ/C) scores and SOFA subcategory variables, and first-day SOFA scores. PU association was determined by logistical regression. Among the 4899 patients in the study population, the overall PU incidence of acquired PUs was 8.1%. Medical patients had significantly more PUs (145/1281; 11.3%) than surgical patients (212/3468; 6.1%) (P <.0001). In all subgroups, significantly more patients with PUs had higher SOFA scores (mean 8.24) than patients without PUs (mean 6.74) (P =.001). The difference persisted when patients with LOS ≥3 days in the ICU were considered. Among the SOFA subcategories, the Glasgow Coma score, renal and respiratory disorders, and hypotension were significantly (P <.0001) linked to PU development. First-day total SOFA score and its cardiovascular and respiratory subcategory scores were the most important predictors of PUs. The total SOFA score provides an additional tool to assess PU risk in ICUs and should be used together with the Braden or the mJ/C Scale.

Incidence and risk factors of pressure ulcers among general surgery patients

Context: Pressure ulcers are among the main postoperative complications which isassociated with an increased length of hospitalization. Determining risk factors of postsurgical pressureulcers is crucial for developing prevention and treatment strategies. Aims: This study aimed to investigate the incidence rate of pressure ulcer and related risk factors after general surgery. Settings and Design: This descriptive cross-sectional study was carried out in three hospitals in Mazandaran province in 2016. Materials and Methods: The sample size was 191 surgical patients undergoing general surgery by using census method. Data were collected in pre-, intra-, and post-operative period using demographic and clinical questionnaires and also, through the Braden Scale for Predicting Pressure Ulcer Risk. Statistical Analysis Used: Descriptive statistics, t-test, Chi-square, and univariateand multivariate logistic regression were used to analyze the data. Results: The incidence rate of postoperative pressure ulcers in patients was 17.8% (34 out of 191 patients). Based on the multivariate logistic regression model, significant correlations existed between the incidence of pressure ulcers and the following variables: age over 70 years old (P = 0.003), history of hypertension (P = 0.035), history of heart diseases (P = 0.029), Braden score Conclusions: Since it is critical to consider the incidence of postoperative pressure ulcers among patients, further measurements are required to identify high-risk people and use preventive protocols by nurses at pre-, intra-, and post-operative levels. Moreover, it requires extra attention in patients over 70 years, those with a history of hypertension and heart diseases, and those undergoing emergency surgery and spinal anesthesia.

Hospital-Acquired Pressure Injury: Risk-Adjusted Comparisons in an Integrated Healthcare Delivery System.

Although healthcare organizations have decreased hospital-acquired pressure injury (HAPI) rates, HAPIs are not eliminated, driving further examination in both nursing and health services research. The objective was to describe HAPI incidence, risk factors, and risk-adjusted hospital variation within a California integrated healthcare system. Inpatient episodes were included in this retrospective cohort if patients were hospitalized between January 1, 2013, and June 30, 2015. The primary outcome was development of a HAPI over time. Predictors included cited HAPI risk factors in addition to incorporation of a longitudinal comorbidity burden (Comorbidity Point Score, Version 2 [COPS2]), a severity-of-illness score (Laboratory-Based Acute Physiology Score, Version 2 [LAPS2]), and the Braden Scale for Predicting Pressure Ulcer Risk. Analyses included HAPI inpatient episodes (n = 1661) and non-HAPI episodes (n = 726,605). HAPI incidence was 0.57 per 1,000 patient days (95% CI [0.019, 3.805]) and 0.2% of episodes. A multivariate Cox proportional hazards model showed significant (p < .001) hazard ratios (HRs) for the change from the 25th to the 75th percentile for age (HR = 1.36, 95% CI [1.25, 1.45]), higher COPS2 scores (HR = 1.10, 95% CI [1.04, 1.16]), and higher LAPS2 scores (HR = 1.38, 95% CI [1.28, 1.50]). Female gender, an emergency room admission for a medical reason, and higher Braden scores showed significant protective HRs (HR < 1.00, p < .001). After risk adjustment, significant variation remained among the 35 hospitals. Results prompt the consideration of age, severity of illness (LAPS2), comorbidity indexes (COPS2), and the Braden score as important predictors for HAPI risk. HAPI rates may be low; however, because of significant individual site variation, HAPIs remain an area to explore through both research and quality improvement initiatives.

Subepidermal moisture detection of pressure induced tissue damage on the trunk: The pressure ulcer detection study outcomes.

We examined the relationship between subepidermal moisture measured using surface electrical capacitance and visual skin assessment of pressure ulcers at the trunk location (sacral, ischial tuberosities) in 417 nursing home residents residing in 19 facilities. Participants were on average older (mean age of 77 years), 58% were female, over half were ethnic minorities (29% African American, 12% Asian American, and 21% Hispanic), and at risk for pressure ulcers (mean score for Braden Scale for Predicting Pressure Ulcer Risk of 15.6). Concurrent visual assessments and subepidermal moisture were obtained at the sacrum and right and left ischium weekly for 16 weeks. Visual assessment was categorized as normal, erythema, stage 1 pressure ulcer, Deep Tissue Injury or stage 2+ pressure ulcer using the National Pressure Ulcer Advisory Panel 2009 classification system. Incidence of any skin damage was 52%. Subepidermal moisture was measured with a dermal phase meter where higher readings indicate greater moisture (range: 0-70 tissue dielectric constant), with values increasing significantly with the presence of skin damage. Elevated subepidermal moisture values co-occurred with concurrent skin damage in generalized multinomial logistic models (to control for repeated observations) at the sacrum, adjusting for age and risk. Higher subepidermal moisture values were associated with visual damage 1 week later using similar models. Threshold values for subepidermal moisture were compared to visual ratings to predict skin damage 1 week later. Subepidermal moisture of 39 tissue dielectric constant units predicted 41% of future skin damage while visual ratings predicted 27%. Thus, this method of detecting early skin damage holds promise for clinicians, especially as it is objective and equally valid for all groups of patients.

Braden scale (ALB) for assessing pressure ulcer risk in hospital patients: A validity and reliability study

PurposeThe inter-rater reliability of Braden Scale is not so good. We modified the Braden(ALB) scale by defining nutrition subscale based on serum albumin, then assessed it's the validity and reliability in hospital patients. MethodsWe designed a retrospective study for validity analysis, and a prospective study for reliability analysis. Receiver operating curve (ROC) and area under the curve (AUC) were used to evaluate the predictive validity. Intra-class correlation coefficient (ICC) was used to investigate the inter-rater reliability. ResultsTwo thousand five hundred twenty-five patients were included for validity analysis, 76 patients (3.0%) developed pressure ulcer. Positive correlation was found between serum albumin and nutrition score in Braden scale (Spearman's coefficient 0.2203, P<0.0001). The AUCs for Braden scale and Braden(ALB) scale predicting pressure ulcer risk were 0.813 (95% CI 0.797–0.828; P<0.0001), and 0.859 (95% CI 0.845–0.872; P<0.0001), respectively. The Braden(ALB) scale was even more valid than the Braden scale (z=1.860, P=0.0628). In different age subgroups, the Braden(ALB) scale seems also more valid than the original Braden scale, but no statistically significant differences were found (P>0.05). The inter-rater reliability study showed the ICC-value for nutrition increased 45.9%, and increased 4.3% for total score. ConclusionThe Braden(ALB) scale has similar validity compared with the original Braden scale for in hospital patients. However, the inter-rater reliability was significantly increased.

Prevention of Pressure Ulcer in Intensive Care Units

Prevention of Pressure Ulcer in Intensive Care Units Fatemeh Ahmadian 1 , Davood Hekmatpou 1 , * , Maryam Eghbali 2 and Shadi Farsaei 3 1 Nursing and Midwifery Faculty, Arak University of Medical Sciences, Arak, IR Iran 2 Isfahan Cardiovascular Research Center, Department of Intensive Care Nursing, Nursing and Midwifery Faculty, Isfahan University of Medical Sciences, Isfahan, IR Iran 3 Pharmacology Faculty, Isfahan University of Medical Sciences, Isfahan, IR Iran Abstract Background: One of the most common problems in intensive care units (ICUs) is pressure ulcer or bed sore and its prevention is a priority in nursing cares. Objectives: The current study aimed to evaluate the effect of henna (Lawsonia inermis) on prevention of pressure ulcers in patients in ICU. Patients and Methods: The current randomized clinical trial was conducted on 80 patients with the inclusion criteria hospitalized in the ICU of Al-Zahra hospital, Isfahan, Iran in 2015. Patients were randomly allocated into two groups of control (40 patients) and intervention (40 patients) by drawing method. For the intervention group, along with the standard prevention cares for pressure ulcers, once a 15 cm thick layer of henna was applied on patients’ sacrum. Data was gathered using demographic data questionnaire, Braden scale to predict pressure ulcer risk and the table to control daily record of skin temperature before the intervention for a week. Data were analyzed using SPSS ver. 21 and Chi-square, Greenhouse Geisser, Pearson correlation coefficient and independent t-test were used in the study. Results: The mean age of patients in the intervention and control groups was 51.35 ± 17 and 52.94 ± 19.61years, respectively. The means of standard deviation score of the Braden scale for all the participants on the first, fourth and seventh day of the study were 12.27 ± 2.85, 14.23 ± 3.21 and 15.73 ± 3.82, respectively, which had significant differences with each other (P < 0.0001); suggesting that the risk of pressure ulcers occurrence was higher on the first day than the seventh day. There was a reverse relationship between reduction of the Braden scale score and increase in local warmth of sacrum (r = 0.558) in both groups. The mean and standard deviation of local warmth of sacrum during the seven days of study were 37.84 ± 0.52 and 38.06 ± 0.67 in the intervention and control groups, but their difference was insignificant (P < 0.14). The mean and standard deviation of local warmth of forehead during the seven days of study were 37.09 ± 0.41 and 37.03 ± 0.44 in the intervention and control groups but their difference was insignificant (P < 0.5). There was a statistically significant difference between the mean local warmth of sacrum and forehead in the intervention group during the seven days of study (P = 0.0001). At the end of the study, one patient in the intervention group (2.7% male) and six patients in the control group (14.29% male, 2.85% female) had developed pressure ulcers; this difference was significant (P = 0.001). Conclusions: Considering the effect of henna in reducing the local warmth, redness, and inflammation of sacrum in patients in intensive care units, application of henna to prevent pressure ulcers for patients at risk of developing pressure ulcers is recommended. Keywords: Intensive Care Unit; Henna; Pressure Ulcer; The Braden Scale; Iran; Lawsonia inermis

Friction of Human Skin against Different Fabrics for Medical Use

Knowledge of the tribology of human skin is essential to improve and optimize surfaces and materials in contact with the skin. Besides that, friction between the human skin and textiles is a critical factor in the formation of skin injuries, which are caused if the loads and shear forces are high enough and/or over long periods of time. This factor is of particular importance in bedridden patients, since they are not moving about or are confined to wheelchairs. Decubitus ulcers are one of the most frequently-reported iatrogenic injuries in developed countries. The risk of developing decubitus ulcers can be predicted by using the “Braden Scale for Predicting Pressure Ulcer Risk” that was developed in 1987 and contains six areas of risk (cognitive-perceptual, immobility, inactivity, moisture, nutrition, friction/shear), although there are limitations to the use of such tools. The coefficient of friction of textiles against skin is mainly influenced by: the nature of the textile, skin moisture content and ambient humidity. This study will investigate how skin friction (different anatomical regions) varies, rubbing against different types of contacting materials (i.e., fabrics for medical use) under different contact conditions and their relationship in the formation and prevention of decubitus ulcers.

Effectiveness of Designed Educational Programme for Nurse&apos;s Regarding Using the Braden Scale to Predict Pressure Ulcer Risk

<i>Introduction: </i>Pressure ulcer prevention and management is an important approach of basic nursing care. Pressure sores affect people who are unable to change position regularly. Sustained pressure on those areas which support the body leads to reduced blood supply and eventually death of the skin and underlying muscles (a pressure sore). <i>Aim: </i>This study was conducted to evaluate the effectiveness of designed educational programme for nurse's regarding using the Braden Scale to Predict Pressure Ulcer Risk. <i>Subjects and method: </i>A quasi- experimental research design was used. Convenience samplings were selected from available nurses worked in the selected setting as following and met selected criteria. It included 99 nurse in port said city at governmental hospitals from ICU and CCU, orthopedics, and medical units at pot said general hospital, Elzohour, Port-fouad hospitals. Data were collected through using one tool contains 3 main parts developed by the researchers based on literature review & modificated tool from <i>Registered Nurses’ Association of Ontario (2006) and Ayello, 2004</i> as follows: <i>Part I: </i>includes Sociodemographic data of nurses; <i>Part II: </i>includes nurse's knowledge regarding Braden scale and <i>Part III: </i>contains Observational checklist in using Braden scale. <i>Results: </i>The study revealeda highly statistically significant difference were found between pre educational programme phase and post educational programme phase in relation to nurse's total scores of knowledge and practice of Braden scale as a predictive risk assessment of pressure ulcer. <i>Conclusion & recommendations: </i>The present study concluded that there are obvious needs for educational programme to increase nurse's awareness of Braden Scale as predictive risk assessment of pressure ulcer.

English

Preventing pressure ulcer has been a nursing concern for many years. The use of risk assessment scales to predict the development of pressure ulcer before it occurs is essential. This study aimed at examining factors that influence the nurses&#39; use of risk assessment scales for predicting pressure ulcer among patients of National Orthopaedic Hospital, Enugu State, South Eastern Nigeria. Descriptive survey design was adopted for this study, and 91 nurses working in the male and female inpatient wards of National Orthopedic Hospital participated in the study. An overwhelming majority [80 (88%)] of the respondents attributed lack of educational training, lack of institutional policy [70 (76.9%)] and no provision of risk assessment forms [51 (56%)] as the major factors affecting nurses&rsquo; use of risk assessment scale. Findings also revealed that only 34 (37.4%) of the respondents have had formal training on risk assessment scale and 51 (56%) of the respondents positively view risk assessment scale as the most appropriate tool for predicting pressure ulcer risk. However, significant relationship reveals that factors have positive impact on usage of risk assessment scale. It was recommended that in-service training or conferences should be organized for nurses working in the setting of the study on how to use risk assessment scales. Also, hospital management should provide policy on use of risk assessment scale and ensure availability of forms to carry out risk assessments to detect pressure ulcer early and improve nursing care of patients. &nbsp; Key words: Pressure ulcer, risk assessment scale, nurses, Enugu State.

Predicting pressure ulcer risk with the Braden Q Scale in Chinese pediatric patients in ICU

The purpose of this study was to (a) observe the value of the score of Braden Q scale in predicting pressure ulcers in pediatric Intensive Care Unit (ICU) patients in China, (b) determine the critical cutoff point for classifying patient risk, and (c) describe the pressure ulcer incidence. A prospective cohort descriptive study with a convenience sample of 198 patients bedridden for at least 24 h without pre-existing pressure ulcers enrolled from a pediatric intensive care unit (PICU). The Braden Q score and skin assessment were independently rated, and data collectors were blinded to the other measures. Patients were observed for up to 3 times per week for 2 weeks and once a week thereafter until PICU discharge. Fourteen patients (7.1%) developed pressure ulcers; 12 (85.7%) were Stage I pressure ulcers, 2 (14.3%) were Stage II, and there were no Stage III or IV pressure ulcers. Most pressure ulcers (64.3%) were present at the first observation. The Braden Q Scale has an overall cumulative variance contribution rate of 69.599%. Using Stage I+ pressure ulcer data obtained during the first observation, a Receiver Operator Characteristic (ROC) curve for each possible score of the Braden Q Scale was constructed. The area under the curve (AUC) was 0.57, and the 95% confidence interval was 0.50–0.62. At a cutoff score of 19, the sensitivity was 0.71, and the specificity was 0.53. The AUC of each item of the Braden Q Scale was 0.543–0.612. PICU patients are susceptible to pressure ulcers. The value of the Braden Q Scale in the studied pediatric population was relatively poor, and it should be optimized before it is used in Chinese pediatric patients.

Nurses’ Interpretation of Patient Status Descriptions on the Braden Scale

The risk of pressure ulcers is widely assessed using the Braden Scale for Predicting Pressure Ulcer Risk, which describes patient characteristics for various severity levels. However, many of these characteristics are described in vague terms that nurses may interpret inconsistently, potentially threatening scale reliability. To examine the consistency of nurses' interpretations of five vaguely described patient characteristics on the Braden Scale we surveyed a convenience sample of 102 nurses and compared their interpretations with those of two nurse experts. The results show large variations in nurses' interpretations. Although the highest frequency of nurses' responses to the majority of descriptions was consistent with the experts' interpretation, the large variation in responses may seriously threaten consistent and accurate assessment of pressure-ulcer risk with the Braden Scale. Our findings suggest that training programs provide operational definitions of these vague patient descriptions, so the Braden Scale can be used consistently in patient care.

Association Between Low Admission Norton Scale Scores and Postoperative Complications After Elective THA in Elderly Patients

The Norton scoring system is used by nurses to evaluate pressure ulcer risk. The authors have previously shown that low admission Norton scale scores (ANSS) are associated with postoperative complications other than pressure ulcers following hip fracture and spine fracture surgery in elderly patients. The purpose of this retrospective, cross-sectional study study was to determine whether low ANSS are associated with postoperative complications other than pressure ulcers following elective total hip arthroplasty (THA) in elderly patients. The medical charts of consecutive elderly (older than 65 years) patients admitted between February 2008 and November 2010 were studied for acute renal failure, cardiovascular events, confusion, pneumonia, pressure ulcers, urinary infection, urinary retention, venous thromboembolism, wound infection, and other complications. The final cohort included 166 patients (108 [65.1%] women; aged 75.2±6.4 years). Overall, 24 (14.5%) patients had low (16 or less) ANSS. Patients with low ANSS had significantly more postoperative complications other than pressure ulcers compared with patients with high ANSS (0.5±0.7 vs 0.2±0.4, respectively; P=.018). Binary regression analysis showed that low ANSS were independently associated with all postoperative complications other than pressure ulcers (P=.039). In addition to predicting pressure ulcer risk, the Norton scoring system may be used for predicting other postoperative complications in elderly patients following elective THA.

Use of mobility subscale for risk assessment of pressure ulcer incidence and preventive interventions: A systematic review.

Pressure ulcers remain a serious problem for patients and providers in healthcare. When a pressure ulcer develops, it can inflict pain and cause untoward complications such as severe infections, surgery, prolonged hospital stay and even death. The objective of this review was to establish whether using the Braden subscale mobility assessment is comparable to using the full Braden pressure ulcer risk assessment scale. However, due to lack of research studies, the focus of this review was extended to include the use of other assessment tools for hospital acquired pressure ulcer risk. Quantitative studies that reported data on mobility and pressure ulcer development or preventive interventions, irrespective of their design were included in the review.The review focused on adult patients admitted to an acute care facility, who underwent a pressure ulcer risk assessment, and had no pressure ulcers on admission.This review considered studies that use Braden mobility subscale assessmentThis review compared the use of full Braden risk assessment scale where available only when it was included within the same study,This review considered: SEARCH STRATEGY: A search for published and unpublished studies from 2000 to 2010 of major healthcare related electronic databases was conducted. Studies in other languages that were translated into English were included in the review. The papers that were selected for possible inclusion were assessed by two independent reviewers for methodological validity using standardised critical appraisal instruments from the Joanna Briggs Institute. Data from included studies were extracted and analysed using Revman5 software. Eighteen studies were included in this review. The findings suggest that the risk of pressure ulcer development was higher when the patient was identified as having impaired mobility, as assessed using the Braden subscale mobility or other similar mobility scales. However, there is little conclusive evidence to indicate that using mobility assessment alone is comparable to using Braden or other risk assessment scales in reducing the incidence of pressure ulcer. Evidence for association between assessment of mobility and endorsement of preventive interventions was significant. However, this finding was based on only one study. No evidence found on the reliability of mobility assessment as a tool to predict pressure ulcer risk. Nor was there evidence on the frequency of assessment using the mobility assessment tool. Assessment of mobility may be a useful measure in an acute care setting in relation to assessing the risk of developing pressure ulcer. However, there is not enough evidence to conclude that mobility assessment alone can replace the more common risk assessment scales such as Braden scale in predicting incidence of pressure ulcer. Further research is required to.

Using the Braden Q Scale to Predict Pressure Ulcer Risk in Pediatric Patients

The Braden Q Scale for Predicting Pediatric Pressure Ulcer Risk (Braden Q Scale) is a widely used, valid, and reliable pediatric-specific pressure ulcer risk assessment tool. Since its original publication, requests for clarification on how best to use the tool across the wide spectrum of pediatric patients commonly cared for in health care systems have been received. Common clarifications focus on using the Braden Q Scale as originally designed; specifically, not using untested derivations of the tool, and not using the Braden Q Scale to predict medical device-related pressure damage. The purpose of this article is to provide practical information on how best to use the Braden Q Scale and how to score a pediatric patient's risk for pressure ulcers. Accurate assessment of patient risk for pressure ulcers is the first step in guiding appropriate nursing interventions that prevent pressure ulcers. Patient assessment, scoring, and common clinical scenarios are presented.

Development of the interRAI Pressure Ulcer Risk Scale (PURS) for use in long-term care and home care settings

BackgroundIn long-term care (LTC) homes in the province of Ontario, implementation of the Minimum Data Set (MDS) assessment and The Braden Scale for predicting pressure ulcer risk were occurring simultaneously. The purpose of this study was, using available data sources, to develop a bedside MDS-based scale to identify individuals under care at various levels of risk for developing pressure ulcers in order to facilitate targeting risk factors for prevention.MethodsData for developing the interRAI Pressure Ulcer Risk Scale (interRAI PURS) were available from 2 Ontario sources: three LTC homes with 257 residents assessed during the same time frame with the MDS and Braden Scale for Predicting Pressure Sore Risk, and eighty-nine Ontario LTC homes with 12,896 residents with baseline/reassessment MDS data (median time 91 days), between 2005-2007. All assessments were done by trained clinical staff, and baseline assessments were restricted to those with no recorded pressure ulcer. MDS baseline/reassessment samples used in further testing included 13,062 patients of Ontario Complex Continuing Care Hospitals (CCC) and 73,183 Ontario long-stay home care (HC) clients.ResultsA data-informed Braden Scale cross-walk scale using MDS items was devised from the 3-facility dataset, and tested in the larger longitudinal LTC homes data for its association with a future new pressure ulcer, giving a c-statistic of 0.676. Informed by this, LTC homes data along with evidence from the clinical literature was used to create an alternate-form 7-item additive scale, the interRAI PURS, with good distributional characteristics and c-statistic of 0.708. Testing of the scale in CCC and HC longitudinal data showed strong association with development of a new pressure ulcer.ConclusionsinterRAI PURS differentiates risk of developing pressure ulcers among facility-based residents and home care recipients. As an output from an MDS assessment, it eliminates duplicated effort required for separate pressure ulcer risk scoring. Moreover, it can be done manually at the bedside during critical early days in an admission when the full MDS has yet to be completed. It can be calculated with established MDS instruments as well as with the newer interRAI suite instruments designed to follow persons across various care settings (interRAI Long-Term Care Facilities, interRAI Home Care, interRAI Palliative Care).

Validity of the Braden and Waterlow subscales in predicting pressure ulcer risk in hospitalized patients

The aim of this study was to evaluate the validity of the Braden and Waterlow subscales in predicting pressure ulcer risk in hospitalized patients. This is a secondary analysis of a prospective cohort study. Braden sensory perception and friction/shear subscales and Waterlow mobility and appetite subscales were the most relevant predictors.