Pressure ulcer risk assessment: retrospective analysis of <scp>B</scp>raden Scale scores in <scp>P</scp>ortuguese hospitalised adult patients

Sardo, Pedro Miguel Garcez; Simões, Cláudia; Alvarelhão, José; Costa, César; Simões, Carlos Jorge; Figueira, Jorge Manuel Rodrigues; Simões, João Lindo; Amado, Francisco; A, Amaro Cendón; Melo, Elsa

doi:10.1111/jocn.12927

Cited by 30 publications

(36 citation statements)

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“…In the current study, the majority of the participants failed to use a risk assessment scale. Sardo et al, (2015) reported similar results to the ones obtained in this current study. This finding can be explained by some nurses' thinking that their clinical evaluation is preferable to the use of a risk assessment scale and that the use of the risk assessment scale is time-consuming.…”

Section: Perceived Barrierssupporting

confidence: 92%

Critical Care Nursesâ€™ Knowledge, Attitudes, and Perceived Barriers towards Pressure Injuries Prevention

Batiha¹

2018

IJANS

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Background: Pressure injuries are a considerable problem for hospitalized critically ill and elderly patients, as such injuries produce pain, and reduce total wellbeing, resulting in increased morbidity and mortality, as well as often extending those patients’ hospital staysPurpose: The purpose of this study was to determine critical care nurses knowledge, attitudes, and perceived barriers toward pressure injuries prevention.Design: A descriptive cross-sectional survey was performed, using a questionnaire method to critical care nurses’. The study took place between August and October 2017 and involved ten hospitals: two university hospital, six public hospitals, and two private hospitals. Methods: Data were collected by means of a questionnaire using two valid and reliable instruments: i) the Pressure Ulcer Knowledge Assessment Tool 2⋅0, and ii) Attitude Toward Pressure Ulcer Prevention and two newly developed instruments sociodemographic and perceived barriers toward pressure injury prevention.Results: The entire mean knowledge score for the participants was 54.9%, and overall high attitude scores were 76.7%. Level of education, years employed in a critical care unit, training received on pressure injury prevention, and the number of papers read on pressure injury prevention was all identified as having a significant and independent effect on participants’ knowledge concerning prevention of pressure injuries. To evaluate the effect of demographic characteristics on nurses’ attitudes, the only significant variable was "years of employment in critical care units". Shortage of staff was the most commonly cited barrier faced by critical care nurses’ during practice.

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Section: Perceived Barrierssupporting

confidence: 92%

Critical Care Nursesâ€™ Knowledge, Attitudes, and Perceived Barriers towards Pressure Injuries Prevention

Batiha¹

2018

IJANS

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“…In particular, the BAS measures the mobility (walking and transferring) level of the hospitalized patient with a score of 1 (“patient is confined to bed”), 2 (“severely limited or nonexistent ability to walk; patient cannot bear his own weight and/or must be assisted into chair or wheelchair”), 3 (“patient walks occasionally during the day, but for very short distances, with or without assistance; he spends majority of each shift in bed or chair”), or 4 (“patient walks outside the room at least twice a day and inside the room at least once every 2 hours during waking hours”). The BAS is correlated with the total Braden scale 10 and has shown excellent interrater reliability (interclass correlation coefficient, 0.96) among hospital staff. 13 Analysis of the current dataset revealed excellent rater agreement across 3 working shifts (κ = 0.76 for first day of hospitalization in those hospitalized <3 days; κ = 0.70 for first day in those hospitalized ≥3 days).…”

Section: Methodsmentioning

confidence: 98%

Prognostic Value of Braden Activity Subscale for Mobility Status in Hospitalized Older Adults

Valiani

Chen

Lipori

et al. 2017

Journal of Hospital Medicine

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OBJECTIVES To evaluate the predictive value of the Activity subscale of the Braden Scale for Predicting Pressure Sore Risk in assessing mobility impairment and recovery among hospitalized older adults. DESIGN Retrospective cohort study. SETTING UF Health Shands Hospital, University of Florida, Gainesville, Florida. PATIENTS 19,769 older adults (≥65 years) hospitalized between January 2009 and April 2014. MEASUREMENTS Incident mobility impairment and recovery were assessed with the Braden Activity subscale (BAS) score that nurses use to grade patients at every shift change (~3 times/d). Posthospital mortality rate and discharge disposition were used to assess the prognostic value of the BAS. RESULTS Of the 10,717 study patients observed “walking frequently” at admission, 2218 (20.7%) developed incident mobility impairment. Of the other 9052 study patients, who were impaired at admission, 4734 (52.3%) recovered to a state of walking occasionally or frequently. Older adults who developed mobility impairment during hospitalization had an odds of death higher than that of those who remained mobile (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.08–1.39). This effect predominately occurred within the first 6 follow-up months. Older adults who recovered from mobility impairment had an odds of death lower than that of those who did not recover mobility in the hospital (OR, 0.54; 95% CI, 0.49–0.59). This effect was slightly stronger within the first 6 months after hospitalization. CONCLUSIONS Nurses’ BAS assessment of mobility status during hospitalization provides substantial prognostic value in hospitalized older adults. The BAS could be an efficient and valuable source of information about mobility status for targeting posthospital care of older adults.

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“…While we had a large number of patient observations during the hospital stay, our measure of mobility impairment is not objectively ascertained as compared to others who have used activity monitors 23 . With that said, the Braden activity sub score has demonstrated good validity and reliability for mobility changes 14 and a strong correlation with the Braden scale which is a validated indirect measure of the mobility status of the patient 13 . Moreover, the mobility status of the patient prior to admission was unknown.…”

Section: Discussionmentioning

confidence: 94%

“…This is why the Braden activity subscale can be used also to assess the mobility level of the patient in a clinical setting. In particular, the Braden activity subscale has demonstrated a strong correlation with the Braden scale at admission and at discharge in assessing pressure ulcer risk and consequently the mobility status of the patient 13 and has excellent inter-reliability among hospital staff with an inter-class correlation coefficient of 0.96 14 . The Braden activity subscale measures the mobility (walking and transferring) level of the hospitalized patient with a score between 1 and 4 where: 1 = “the patient is confined to bed”; 2 = “ability to walk severely limited or non-existent; the patient cannot bear his own weight and or must be assisted into chair or wheelchair”; 3 = “the patient walks occasionally during the day, but for very short distances, with or without assistance; he spends majority of each shift in bed or chair”; 4 = “the patient walks outside the room at least twice a day and inside the room at least once every 2 hours during waking hours”.…”

Section: Methodsmentioning

confidence: 99%

In-Hospital Mobility Variations Across Primary Diagnoses Among Older Adults

Valiani

Gao

Chen

et al. 2016

Journal of the American Medical Directors Association

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Objectives To examine the relationship between primary diagnoses and mobility impairment and recovery among hospitalized older adults. Design Prospective cohort study. Setting UF Health Shands Hospital, an 852-bed level I trauma center located in Gainesville, Florida. Participants 18,551 older adults (≥65 years) with 29,148 hospitalizations between 1/2009 and 4/2014. Measurements Incident and discharge mobility impairment and recovery were assessed using the Braden activity subscale score that was recorded by the nursing staff at every shift change–approximately three times per day. Primary diagnosis ICD-9 codes were used as predictors and re-categorized by using the Agency for Health Care Research and Quality Clinical Classification Software. Results Out of the 15,498 hospital records where the patient was initially observed to “walk frequently”, 3,186 (20.6%) developed incident mobility impairment (chair-fast or bedfast). Primary diagnoses with a surgical or invasive procedure were the most prevalent (77.2 %) among the hospital observations with incident mobility impairment; otherwise primary diagnoses without surgery were much more associated with discharge mobility impairment (59%). The highest incidence of mobility impairment occurred in patients with heart valve disorders and aortic and peripheral/visceral artery aneurysms (6.24 and 6.05 events per 30 person-days, respectively); septicemia showed the highest incidence rate for mobility limitation at discharge (0.94 events per 30 person-days). Mobility impairment was observed in 13,650 (46.8% of total) records at admission and 5,930 (43.44%) were observed to recover to a state of walking occasionally or frequently. Osteoarthritis and cancer of gastrointestinal organs/peritoneum had the highest incidence rate for mobility recovery (7.68 and 5.63 events per 30 person-days respectively). Conclusions Approximately 1 out of 5 patients who were mobile at admission became significantly impaired during hospitalization. However, about half (43.4%) of patients observed to have mobility impairment at admission recovered during hospitalization. Conditions most associated with mobility impairment and recovery are varied, but older patients hospitalized for septicemia and cardiovascular diseases with surgery (heart valve disorders and aortic/peripheral/visceral artery aneurysms) appear to be at most risk for incident mobility impairment that did not recover at discharge.

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Pressure ulcer risk assessment: retrospective analysis of Braden Scale scores in Portuguese hospitalised adult patients

Cited by 30 publications

References 30 publications

Critical Care Nursesâ€™ Knowledge, Attitudes, and Perceived Barriers towards Pressure Injuries Prevention

Critical Care Nursesâ€™ Knowledge, Attitudes, and Perceived Barriers towards Pressure Injuries Prevention

Prognostic Value of Braden Activity Subscale for Mobility Status in Hospitalized Older Adults

In-Hospital Mobility Variations Across Primary Diagnoses Among Older Adults

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