FOURTEENTH ANNUAL EUROPEAN PRESSURE ULCER ...

Thursday September 1st
Proceedings of the 14th Annual European Pressure Ulcer Meeting
Oporto, Portugal
With or without a risk assessment scale? An evaluation of the impact of the Braden Scale on
allocation of preventive interventions to traumatological patients
Sylvia Mallison 1 , Laura Kremer 1 , Anne Junghans 1 , Katrin Balzer 1
1 Institute for Social Medicine, Universität zu Lübeck, Germany, katrin.balzer@uk-sh.de
Introduction
Traumatological patients are exposed to increased
pressure ulcer (PU) risk but seem to be systematically
under-supplied with preventive measures [1]. To date
the evidence whether use of a pressure ulcer risk
assessment scale (PURAS) improves PU preventive
care in hospital patients is lacking [2]. Therefore,
following research question was investigated: Does
routine use of the Braden Scale (BS), one of the
widespread PURASs in German hospitals, increase
the number of traumatological patients at high PU risk
receiving adequate preventive measures?
Methods
A quasi-experimental study was conducted in 2
independent traumatological wards at one university
hospital. In ward A, nurses regularly used the BS
along to their clinical judgement over a period of 6
months (intervention periods 1+2). In ward B, for 3
months nurses appraised patients’ PU risk based on
their clinical judgement alone (intervention period 1).
They were asked to regularly document their
assessment result by means of a four step global
judgment scale. After this period, nurses in ward B
also used the BS along to their clinical judgement
(intervention period 2) (Fig. 1).
Fig. 1: The trial setup. (*assessment of current state of
preventive practice, **Training in use of Braden Scale before
start of intervention phase 2, mo=months)
Patients aged ≥18 years, not suffering from PU >grade
1 and having an expected length of hospital stay ≥5
days were eligible for consecutive inclusion.
Data were collected by trained study assistants who
regularly observed patients for presence of risk
factors, preventive interventions and PU. Primary
endpoint was presence of adequate preventive
measures when patients were noted to be at high PU
risk for the first time during follow-up as assessed by
study assistants. Prevention was considered adequate
85
if patients at high risk received two pressure-relieving
interventions at least, e.g., repositioning, pressureredistributing
support surface, or offload of the heels.
Results
In total, 571 patients were included, with 377 being
assessed at high PU risk (232 in intervention periods 1
or 2). Univariate analysis revealed non-significant
differences between study groups in the primary
endpoint. However, these differences are inconsistent
in direction and size of impact of BS (Tab. 1).
Table 1: Univariate results for primary endpoint
Patients with ≥2
pressure-relieving
measures (%)
Ward A: periods
27 (27 %)
1+2 (BS) n=100)
Ward B: period 1
19 (25 %)
(GJ) (n=76)
Ward B: period 2
8 (15 %)
(BS) (n=55)
BS=Braden Scale, GJ=Global Judgement
Odds Ratio (95 CI)
Inter-group Intra-group
1,11
(0,21-2,19)
0,51
(0,21-1,27)
Discussion
Use of the BS seems to have had no clear-cut effect
on allocation of preventive measures to patients at
high PU risk in this trial. Further analyses are required
to control for the impact of baseline differences
between study groups. Explorative analyses are
planned to identify clinical characteristics of patients
whose risk is likely to be overseen and to assess the
impact of sub-adequate prevention on PU incidence.
Clinical relevance
Results from awaiting trial analyses are expected to
reveal critical issues for improving nurses’ PU risk
assessment and preventive care in traumatological
patients.
Conflict of Interest
This trial was funded by a grant of the foundation
B. Braun Stiftung. The funding source had no role in
design and conduct of the study. All authors declare
that they have no conflict of interest.
References
[1] Baumgarten M. et al., Gerontologist. 50: 253-262,
2010
[2] Kottner J. et al., J Multidiscip Healthc 3:103-111,
2010.
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