Risk assessment is recommended upon admission to a nursing home and weekly for the first month. Risk status can be effectively predicted by using the Braden Scale in combination with knowledge of age, blood pressure, temperature, and dietary protein intake.

Studies related to the treatment of pressure sores have appeared in the literature. Questions remain regarding both the etiology and treatment. This article presents a conceptual schema within which current knowledge can be organized and examined and further study facilitated. The critical determinants of pressure sores are primarily the intensity and duration of pressure. A second critical concept, the tolerance of the tissue for pressure, is also discussed. Conditions contributing to prolonged and intense pressure are included within the concepts of mobility, activity, and sensory perception. Tissue tolerance for pressure is influenced by both extrinsic and intrinsic factors. Extrinsic factors such as moisture, friction, and shear impinge on the skin and underlying tissues, while the multiple influences of nutrition, the physiologic effects of stress, aging and alterations in cellular respiration are intrinsic factors which influence the architecture and integrity of the skin and supporting structures. The schema provides broad categories capable of organizing existing knowledge and new findings.

Risk assessment, rather than diagnoses or demographic characteristics, is recommended as the basis for prescriptive decisions. Risk assessment should cue health care providers to make more judicious use of turning and support surfaces to prevent pressure ulcers. Persons who are at risk for pressure ulcers should have turning and pressure reduction surfaces consistently prescribed and implemented. The costs and goals of preventive prescription for those not at risk for pressure ulcers should be considered.

Studies related to the treatment of pressure sores have appeared in the literature. Questions remain regarding both the etiology and treatment. This article presents a conceptual schema within which current knowledge can be organized and examined and further study facilitated. The critical determinants of pressure sores are primarily the intensity and duration of pressure. A second critical concept, the tolerance of the tissue for pressure, is also discussed. Conditions contributing to prolonged and intense pressure are included within the concepts of mobility, activity, and sensory perception. Tissue tolerance for pressure is influenced by both extrinsic and intrinsic factors. Extrinsic factors such as moisture, friction, and shear impinge on the skin and underlying tissues, while the multiple influences of nutrition, the physiologic effects of stress, aging, and alterations in cellular respiration are intrinsic factors which influence the architecture and integrity of the skin and supporting structures. The schema provides broad categories capable of organizing existing knowledge and new findings.

The predictive validity of the Braden Scale and the timing of assessment for optimal prediction of pressure sore development (PS) were studied in a nursing home population. Subjects (N = 102) over age 19, free of PS and admitted within the previous 72 hr, were randomly selected from consecutive admissions to a skilled nursing facility. Subjects were assessed for risk and skin condition every 48 to 72 hr for 4 weeks. Twenty-eight subjects (27.5%) developed a PS. A cut score of 18 used at the observation prior to the first recorded PS maximized prediction, producing a sensitivity of 79%, a specificity of 74%, a 54% predictive value of a positive test, 90% predictive value of a negative test, and 75% correct classification rate.

1. Identify the purpose and benefits of using a pressure ulcer risk assessment scale. 2. Evaluate pressure ulcer risk by using the Braden Scale and its subscales. 3. Identify the interventions that can be implemented based on the patient's Braden Scale score.

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Risk assessment on admission is important for timely planning of preventive strategies. Ongoing assessment in SNFs and VAMCs improves prediction and permits fine-tuning of the risk-based prevention protocols. In tertiary care the most accurate prediction occurs at 48 to 72 hours after admission and at this time the care plan can be refined.