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