Risk assessment and risk-based programs of prevention in various settings.

An assortment of screening tools exist to estimate risk for pressure ulcer development. The Braden Scale has undergone testing in several settings which guide users in answering the following questions: Who should assess risk? Does cut-off score differ by setting? Does timing of assessment vary by setting? Is formal risk assessment necessary? How does risk assessment fit into a program of prevention? Based on these studies, RNs are able to use the Braden Scale more reliably than Nurse Aides and LPNs. While the Braden Scale does not replace clinical judgement, its use will help caregivers of all levels to identify at risk patients and intervene for specific risk factors. Generally, all patients should be assessed upon admission and 24 to 48 hours later, followed by ongoing assessment. A formal risk-based program is effective in both reducing the incidence of pressure ulcers and the costs associated with prevention. Protocols can be developed to address each level of risk, with each level requiring more aggressive preventive modalities. Some investigators have also tied interventions to specific subscale scores. It is important that risk assessment and risk-based protocols such as the Braden Scale become a standard of practice in all healthcare settings.