Computer-based testing of the Braden Scale for Predicting Pressure Sore Risk.

The Detroit Medical Center nursing documentation system requires all staff nurses to complete the Braden Scale for Predicting Pressure Sore Risk on an Acute Care Flow Record or Critical Care Flow Sheet on every patient, every day. An audit of these records raised concern as to whether staff nurses accurately used the Braden Scale to calculate pressure sore risk. Advanced Practice and ET Nurses noted that staff nurses were rating patients at lower levels of pressure sore risk than was warranted by the patient condition. In response, a computer-based learning module with case study examples was developed and tested to teach nursing staff to accurately evaluate pressure ulcer risk by using the Braden Scale and its subscales and to identify preventive interventions based on the patient's Braden subscale scores. Following revisions of those case study example narratives that were found to be problematic, the learning/assessment module was instituted in 2002. More than 2,500 nurses at the facility were tested regarding their knowledge of pressure ulcer risk assessment and prevention using this program. On average, nurses correctly rated the Braden Scale level of risk 75.6% of the time. The percentage of correct responses was highest for very high (92%) and very low (78%) levels of risk. This finding is consistent with the observation that most nosocomial pressure ulcers in this facility occur in patients who are rated in the "mild risk" level on the Braden scale. Subscales with the lowest percentage of correct answers were moisture and sensory perception. Correct clinical identification of a Stage I pressure ulcer as it was described in writing occurred only 53% of the time. These results indicate that training and practice are needed to use an assessment scale accurately. The Detroit Medical Center plans to include the Braden Scale in annual nursing education and competency testing.