Is the Braden Scale a comprehensive skin risk assessment?

Preventing pressure injuries and skin breakdown begins with a comprehensive risk assessment. Most providers use a skin risk assessment tool such as the Braden. While this tool has been validated to predict pressure injury development, the Braden alone isn’t a comprehensive skin risk assessment, and frequently the individual risk factors the Braden identifies aren’t carried through to the plan of care.

A comprehensive assessment for risk of skin breakdown may include a validated tool such as the Braden Scale, but clinicians also should look for risk factors not included on the tool. For example, if your staff uses the Braden Scale, you would also want them to consider other risk factors, including diagnoses, medications such as steroids, history of skin breakdown, cognition, low albumin or pre-albumin, the patient’s choice to follow the interventions, the use of medical devices, head-of-bed elevation, etc.

Thus, once the Braden is completed, clinicians also should look at the medical record for the current history and physical, diagnoses list, medications and treatments, lab values, physician orders, care plan, etc. The clinician also should perform a head-to-toe skin assessment and interview the resident, representative and staff.

After completing the comprehensive risk assessment, the next step is creating the plan of care. All individual risk factors identified from the medical record review, head-to-toe skin assessment and interviews should be brought forward to the care plan. In addition, staff should evaluate the Braden Scale sub-scores to help identify what is putting the resident at risk. For example, if a person scored poorly under mobility and nutrition, these areas should be addressed in the plan of care.

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