Using the Braden Scale to get from Risk to Interventions
Can a simple score predict a life-threatening bedsore? The Braden Scale is a powerful tool used in nursing homes to spot pressure injury risks before they become serious problems. But knowing the risk is only half the battle—taking the right steps afterward is what truly matters. In this week’s episode, nursing home abuse lawyer Rob Schenk welcomes guest Tracey Yap to talk about how to use the Braden Scale effectively, moving from risk assessment to real interventions that protect residents.
Schenk:
How the Braden scale translates to pressure injury preventions interventions? Stick around.
Hey out there. Welcome back to the Nursing Home Abuse podcast. My name is Rob will be your host for this particular episode. Today we are talking about getting into the weeds a little bit today, but the idea of how. The Braden Scale, which is a, an assessment to essentially assess your likelihood of developing a pressure injury.
How the Braden scale translates to specific interventions, like how do we get from a number I. On the Braden scale to X, Y, and Z, which would appear on the care plan. But we’re not having that conversation alone. We have the fantastic Dr. Tracy Yap on the program today to walk us through that process.
But again, we have. Yap with us today. Dr. Yap is a professor at Duke University School of Nursing and a senior fellow at Duke Center for the Study of Aging. Her research focuses on improving care quality through evidence-based mobility practices to prevent pressure injuries, and nationally recognized neuroscientist.
Dr. Yap has received funding from leading institutions and was honored with the Presidential Early Career Award for scientists and engineers. In 2019 and we are absolutely elated to have her on the show. Dr. Yap, welcome to the show.
Dr. Yap:
Thank you.
What is the Braden Scale?
Schenk:
Softball question to start off with. Sure. What is the Braden Scale and what does it do?
Dr. Yap:
So the Braden Scale is a scale that sort of ke it has a total score. It’s a range between six and 23. And the idea is the higher the score, the less your risks. R of developing a pressure injury. So there’s six subscales within that. So they each can standalone. So there’s like a nutrition subscale, there’s a activity, mobility, subscale, friction, and share.
So each one of these scales is built into a total score and then that overall tells nursing staff, this is the overall risk of this individual for getting a pressure. They start worrying when the score’s quite low, right? They’re really paying attention to each thing.
Review the latest research on the impact of preventive health measures in elderly populations.
What does the total score represent? Specific risk factor scores?
Schenk:
So the $64,000 question. Then it, for the people that are of a certain age that know what that means is once you have a number, and let’s say the number is low on the low end.
Where do we go from there? Okay, great, the person is a high risk. What next?
Dr. Yap:
So then you start paying attention. Where are they specifically at risk? So if they’re at risk for moisture, for example. So say they have incontinence issues, right? What happens if the incontinence is the skin gets denuded, and then the when you’re in a bathtub and you’re, or you’re swam too long and you’re.
Your fingers get all wrinkly. That’s denuded, right? And when that happens to your skin, it becomes weaker. So it’s easier to tear puncture, that kind of stuff. So that’s the kind of things they’re looking for. They’ll have a scale that measures moisture in terms of are they moist all the time, all the way to, they’re rarely moist, right?
So let’s say they’re moist all the time. Then you’re looking at interventions like you put in moisture wicking briefs. And then that idea is the brief will then absorb the moisture the urine, whatever, the incontinence, and then keep it away from the skin.
Explore clinical insights on using the Braden Scale for pressure ulcer risk assessment and its effectiveness in long-term care settings.
How do you get from the score to interventions?
Schenk:
When looking at the. Essentially the six subsets. Where there might be subscales. Subscales. Yeah. Thank you. There might be an instance in which one, subscale the person is at no risk. Correct. Or has the minimum, but another one there’s high. So if I, from what I understand you correctly, is the nursing home. In an ideal world, wouldn’t just take the total number.
They would look at the subscales that are problematic and then at, and then try to address each one of those.
Dr. Yap:
Yeah, they attend to them. And the problem with the total scale, in my opinion and I’m an interventionalist I run large scale clinical trials for research. And what happens when you go for that total scale.
It’s nice to know that somebody is in that risky area or what have you, but really, I. Specifically when I’m running an intervention, I wanna know what that area is, right? Because the total score can obscure it, like some low, if they’re getting a one, for example, on moisture, but they have great nutrition and mobility and stuff, they’re Yeah.
Learn how facilities can reduce ulcer incidence by implementing Braden Scale-driven protocols.
Schenk:
Cognitively okay. Things like that, right?
Dr. Yap:
So that’s the thing it’s overall the idea’s great, but I think personally you. The individual scales are better indicators. So I work a lot with repositioning and trying to determine where the safe level of repositioning is. Can we extend it out to every four hours, which is where our research lies, right?
So I’m very interested in mobility and activity. So to me, those subscales are better indicators of risk.
Gain insights into wound assessment strategies for residents at risk of pressure ulcers in clinical environments.
Are there any interventions that should always follow from a particular total score or specific risk factor score?
Schenk:
Does the Braden scale say anything? And let me be more specific. Does the, did the subscales of the Braden scale say anything about what you should do if there’s a certain number? So for example, you brought up, we we’ve talked about the moisture thing.
So and you brought up possibly moisture wicking materials, but is that something that is just in your experience in nurse judgment or is that a part of the Braden scale tells you?
Dr. Yap:
Oh, the Braden scale doesn’t tell you. It just tells you where the weakness is. And so then your strategies in place, you’ll have protocols in every nursing home saying, this is what we do.
If they’re, if they’re chair fast their ability then is to walk. They need a two man assist or what have you. Like they’ll make those assessments right.
Read more about best practices in preventing pressure ulcers with the Braden Scale as discussed in AJN: American Journal of Nursing.
Schenk:
Okay, so I see, so it’s a matter of, it would be literally either the nurse’s judgments or the nurse’s judgment pursuant to whatever the policies and procedures are of the nursing home with respect to that score.
Dr. Yap:
Correct. Yeah.
Schenk:
Okay. So I guess that, that could potentially leave a wide spectrum of things that you could do to address each individual subscale.
Dr. Yap:
Sure. And it’s gonna depend on what you have available to you for resources. So we always know these. Nursing homes are strapped. They’re always run running on a sort of skeleton crew and the bare necessities, if you will.
They’re doing the best they can do with what they have. And I’ve worked enough now in nursing homes and research to see that the staff there are amazing with what they can do, with how little they have. Very committed.
Understand the basics of what the Braden Scale is and how it helps assess bedsore risk in nursing home residents.
Schenk:
So in your experience, or at least in, do your clinical trials tell you anything about.
A th like a floor. Like in other words, if e although we just talked about things should be done spec, the intervention should be created that are specific to the subscales. But is there like a floor, like if the person scores X, Y, and Z, either total or individually on the subscales, do this bar nothing else.
No matter what your policies and procedures are, you need to be doing this, or this. Is there anything, any intervention that’s like that?
Dr. Yap:
No, because it’s a, the, each subscale is different, right? You would treat, like for nutrition for example, if they’re really horrifically malnourished, you’re bringing in a dietician.
So they’re gonna bring their expertise and deal with that, right? Same with mobility and activity. You got physical therapy, that’s also gonna get involved and they’re gonna have their setups in terms of addressing whatever the weaknesses are. So I think that’s. Where you’re at with that.
There’s nothing, there’s not an overall answer to it. It’s just more or less bringing awareness. It’s step one. You think about it, you come through the doors. We gotta know where your baseline is. We gotta do a, the best we can do with something we don’t know about. And then, it’s reassessed on a regular basis, right? Depending on whether you’re getting better or worse.
Learn practical techniques for how to prevent bedsores before they become serious injuries.
Schenk:
So I guess that, that makes sense. There’s nothing, there’s no specific intervention that is going to follow every time based on an XX score.
Dr. Yap:
No.
Why is turning/rep so critical to pressure injury prevention?
Schenk:
Okay. It wouldn’t be the case then that like for example, if somebody scored a four, they’re gonna automatically need a turning repositioning schedule.
It’s because maybe their mobility is high or their, and their cognitive capacity is high, but everything else is low. For example, like they wouldn’t. You wouldn’t have to have that.
Dr. Yap:
So think about it this way. So where I focus on mobility and activity, I wanna know, are you able to reposition yourself in bed or do I have to make sure that a nurse, nursing staff is coming in there every two hours to reposition you? And then the same with when you’re out of bed, do you need one or two person assist? Because the idea with a pressure injury is that if you sit too long or you lay too long, that external pressure is compromising your circulatory and your perfusion, your tissue profusion, and that’s what’s causing the ulcer.
Explore common causes and complications of bedsores in nursing home settings and what families should look out for.
That’s our current belief. Okay. And so that’s where that comes from. This is because your outcome could be this. If you stay in a position too long, we wanna make sure that we’re addressing any time that you’d be in a, an extended period. And like I said, nutrition will have diet dietician that will say, you’re low on protein.
This is what we’re gonna do. We’re gonna give you protein boosters, or shakes, or. So each subscale is being addressed individually, you have the total risk, but we’re addressing that risk by targeting the subscales.
Find out what a bedsore is and why it occurs in elderly patients under long-term care.
Schenk:
Is there any type of manual or Bible for pressure injury? Prevention interventions, like even if there’s not specifically a, do one, two, a three based on a brain scale, if there’s some type of go-to. Document that nurses go by that tells you what to do.
Dr. Yap:
Yeah. So there, the Wound Healing Society, for example, has guidelines and then of course the National Oppression Injury Advisory Panel has guidelines. There is things out there that will tell you or give you suggestions, but there’s no one sort of Bible, if you will.
There’s. Strengths and weaknesses to anything. So if I was, if I had a family member and I didn’t quite know. Yeah. Getting online, now with ai, I mean you can use chat GPT for free or clawed for free or perplexity. And they’ll give you so ma, so much time to do your research. If it was me, I would.
Not that I, I don’t own any stocks and perplexity, but I think it’s a great little search engine. Like it, it not only will, you can type in your question, what are the best things to do for mobility for somebody, right? And it will give you the latest research, it’ll give you the citations, and you can be linked right to those citations. So inform yourself.
If your loved one has suffered due to pressure ulcers, consider reaching out to an Atlanta Bedsore Lawyer for legal support.
Schenk:
I never even heard of perplexity.
Dr. Yap:
So that’s, it’s just, the world is moving so fast right now. It’s insane. But information is there. If you can use it, if if you’re willing to go on there and investigate.
Schenk:
Folks, I hope that you found this episode educational.
If you have an idea for a topic that you would like for me to talk about, please let me know. If you have an idea for a guest that you would like for me to talk to, please let me know that as well. New episodes of the Nursing Home Abuse Podcast come out every single Monday. And remember folks to ignore my desperate please for you to please take a nursing home abuse podcast, coffee mug.
It’s hard to be looking at two gigantic boxes of coffee mugs every day as I walk past them. Anyway, with that folks, we’ll see you next time.
Related Episodes:
- Episode 121 – Five Ways to Prevent Pressure Ulcers in Nursing Homes
- Episode 118 – Preventing Pressure Ulcers in Nursing Homes
- Episode 135 – Understanding Pressure Ulcer Staging
Episode 201 – Unpacking the Truths About Pressure Injuries in Nursing Homes - Episode 208 – Top Three Crucial Data Points from the MDS About Pressure Injuries
Dr. Tracey Yap’s Contact Information:
- Dr. Tracey Yap on X