NURSING ASSESSMENT OF PRESSURE SORE RISK

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The specific aim of this study is to establish the validity of the Braden Scale for Predicting Pressure Sore (PA) Risk. More specifically, the study aims for the first phase of the study are to (a) identify the critical cut-off score at which risk is accurately predicted, (b) determine the misclassification rate of the critical cut-off score, (c) determine the influence of age, sex, race, diagnosis and other factors on the predictive validity of the Braden Scale, (d) identify the frequency of reassessment necessary to accurately predict changes in PS risk among inpatients and home health care patients, and (e) compare the predictive validity of the Braden Scale in home health care practice versus inpatient acute and long-term care settings. In a second phase, the risk classification accuracy of the scale will be tested in a new population. The study will be conducted in four acute care hospitals, three nursing homes, and two home health agencies. The same prospective design will be used in each setting. Subjects meeting the following criteria will be randomly selected from each setting: (a) PS free on admission to the study, (b) expected length of hospital/institutional stay at least ten days or expected duration of home care of one month, (c) home care patients are home bound, and (d) subjects agree to participate. PS risk will be assessed using the Braden Scale, and demographic data will be recorded from patient records or by interviewing the patient. A nurse who will remain blind to the risk assessment score will systematically assess skin condition. Inpatients will be studied by assessing risk and skin condition three times per week for a maximum of four weeks or until discharge from the institution. Home care patients will be studied through weekly assessments for a maximum of four weeks. Preventing PS is undoubtedly less costly than treatment, but prevention is also expensive. Protective devices such as special beds may cost $85/day or more. Accurate prediction of risk will permit preventive treatments and devices to be ordered in a timely manner for patients at risk while reducing the unnecessary and costly treatment of persons who are not at risk for developing PS.