The Effectiveness of the Braden Scale as a Tool for Identifying Nutrition Risk

The Effectiveness of the Braden Scale as a Tool for Identifying Nutrition Risk

Pressure injuries are areas on the skin with to decreased blood flow to the area causing cell death and tissue damage.  They affect many hospitalized patients and cause increased risk of infection and pain.  Complications of a pressure injuries are also very costly to hospitals, including penalties from Medicare and Medicaid Services if there are high rates of hospital-acquired infections.  Hospitals, therefore, want to prevent infections such as pressure injuries so there are screening tools in place to assess the risk and need for intervention. Nutrition plays a big role in skin integrity.  Decreased energy and protein intake increase the risk of pressure injuries so it is important to assess intake when screening for nutrition risks.   Poor nutrition increases the risk of developing pressure injuries and slows the healing process.  Nutritional intervention is essential for those with high risk of developing pressure injuries and malnutrition.

The Braden scale was developed to assess the risk of developing pressure injuries in clinical settings.  The scale uses categories such as sensory perception, moisture, activity, mobility, nutrition, and friction and shear to determine risk.  The lower the Braden score, the higher the risk of pressure injuries.  It is controversial of the effectiveness of using this tool to determine a need for nutrition intervention.  It has been found that the Braden Scale may be over-predictive.  If someone has a high Braden score, this does not necessarily mean they will develop a pressure injury, so therefore the validity is questionable. 

The Malnutrition Screening Tool (MST) assesses nutrition status to identify malnutrition risk and the need for intervention by the registered dietitian.  Those with malnutrition have a higher risk of developing pressure injuries in the hospital so it important to assess nutrition status.  Its important to determine which patients are at increased risk for malnutrition and pressure injuries in order to provide intervention.  Those at high risk for pressure injuries might not necessarily be at high risk for malnutrition and intervention though.

In this study, most patients were not a malnutrition risk according to the MST, yet most of those scored mild to severe on their Braden scores.  Conversely, the ones that were a high risk for malnutrition, only a small number were a high risk on the Braden scale.  The two tests may not be correlated to identify the need for nutrition intervention.  Using the Braden scale for nutrition intervention may be creating more work for the dietitians than necessary.  Using the MST to assess malnutrition is a better tool to use to identify the need for nutrition intervention.  Interaction among the care team is important in identifying the need for further nutrition intervention in those at high risk for pressure injuries and for the prevention of those infections.

I found this article very interesting because the long-term care facilities that I am currently at use the Braden Scale to determine nutrient needs.  Residents that score at risk on the scale automatically get higher calorie and protein recommendations and interventions to meet those needs.  They have this in place in order to prevent pressure injuries, however, even the slightest risk triggers this intervention, which in some cases, might not be necessary.

NT

Phillips, W., Hershey, M., Willcutts, K., & Dietzler-Otte, J. (2017). The effectiveness of the Braden Scale as a tool for identifying nutrition risk. Journal of The Academy of Nutrition And Dietetics, doi:10.1016/j.jand.2016.11.012