Braden Scale cumulative score versus subscale scores: are we missing opportunities for pressure ulcer prevention?

BACKGROUND: Hospital-acquired pressure ulcer incidence rates continue to rise in the United States in the acute care setting despite efforts to extinguish them, and pressure ulcers are a nursing-sensitive quality indicator. The Braden Scale for Predicting Pressure Sore Risk instrument has been shown to be a valid and reliable instrument for assessing pressure ulcer risk. CASE: This case study represented 1 patient out of a chart audit that reviewed 20 patients with confirmed hospital-acquired pressure ulcers. The goal of the audit was to determine whether these ulcers might be avoided if preventive interventions based on Braden subscale scores versus the cumulative score were implemented.
CONCLUSION: This case study describes a patient who, deemed at low risk for pressure ulcer development based on cumulative Braden Scale, may have benefited from interventions based on the subscale scores of sensory perception, activity, and mobility. Further research is needed to determine whether interventions based on subscales may be effective for preventing pressure ulcers when compared to a protocol based exclusively on the cumulative score.