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
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