Why the Braden Scale Is Accurate but Doesn’t Work—and the Very Simple Thing You Can Do About It

Pressure injuries (PI) are all too common, and today’s nurses are hindered by a broken process. Despite assessment tools, clinical knowledge, and the best intentions, nurses are often pulled in so many directions that prevention work can feel like an uphill battle. Gwen Jewell, of Jewell Nursing Solutions, is a wound care specialist and has a passion for seeking solutions to reduce pressure, keep patients more comfortable, and assist nurses in the fight against pressure injuries. “When I first started doing clinical quality improvement work for pressure injury prevention, the first thing that came up was that nobody knew who was at risk for pressure injury. Nor did anybody know which patients on the units already had a pressure injury. For various reasons I won’t get into here, somewhere along the line, the art of PIP care was slipping further down the priority totem pole. Routine Braden Scale risk assessment (at the bedside) was the first to go. Not that nurses weren’t doing the Braden Scale—they were. Every shift, for every patient. But they were doing it at their desk on the computer, not at the bedside where it really matters. The problem was, and still is, literally no nurse I talked to could tell me what score their patients got. Neither were they able to tell me what score indicated high risk for PI, nor what the six questions were. But when I asked them about a specific patient, they could ponder with me about why—or why not—the patient was at risk, with fair accuracy.” The knee-jerk reaction is to assume this is a training issue; that somehow, we have to “get” the nurses to “use it”. But the problem is not with the nurses. And it’s not with the tool. The problem is the way the process is set up. Nurses answer the Braden questions at the desk when they get the time to sit and chart. They can answer those questions in their sleep. They are not assessing their patient for risk; they are just answering the questions. When they are at the bedside, they are passing meds, taking vitals, checking results, talking with patients and families, and listening to lungs. With the thousands of things a nurse must do each time they walk into the room, pressure injury prevention is the least of their concerns. Not only is a patient’s Braden score rarely top of mind for the nurse; in practice, a number is not what matters most. The only thing that matters is: Can and does the patient offload pressure points as needed and protect their skin from moisture, friction, and shear? Or do we have to do it for them? The greatest challenge to pressure injury prevention in acute care is making it a priority. The biggest issue for nursing is keeping it in their psyche—making it a “habit.” The solution is simple, but not easy. Nurses need to do the Braden assessments at the bedside when they are in the room. Fortunately, it can be done faster and more accurately than the score. Here’s a video to show you how: QUICK & EASY BEDSIDE BRADEN ASSESSMENT DEMO To download The Ultimate Guide: How to Stop Bedsores,  click the title or click here. Jewell Nursing Solutions’ mission is to empower all caregivers to prevent and heal pressure injury wounds. For more information, contact us HERE.