Audit of The Effective Use of the Braden Scale

Aim The aim of this audit was to establish the level of Braden Pressure Ulcer Risk Assessment Tool (BPURAT) documentation by nursing staff on the adult in-patient population with stage 3 or 4 pressure ulcers (PU) present in an East Midlands Hospital Trust. The recommendations from the Nottingham University Hospital’s essence of care benchmarks (2010) and the National Institute for Clinical Excellence (NICE) pressure ulcer guidelines (2005) were used to assess compliance. Background The PU plagues up to 10% of the hospitalised population (Clark 2004). They are a frustratingly regular complication of disability and illness which can be fatal if not treated effectively (Bo 2003, Dealey 1992). It is this inherent risk to patient well being that determines why the documentation of this ailment is so vital in the struggle for better outcomes for the individuals who find themselves at risk. Methodology A retrospective clinical audit was implemented in order to collect 25 patient records from the preceding 12 months since the standardised implementation of the BPURAT in 2010. This accounted for 50% of those who had had a stage 3 or 4 PU within the Trust since the standardisation. Results consisted of nominal data that was not appropriate for statistical testing. Results were therefore tabulated by frequency and percentage and presented in graphs where appropriate. Results Compliance with Trust guidelines and NICE (2005) was poor. Only one Trust recommendation was met regarding the documentation of in-patient nutrition. All other areas failed to comply with Trust recommendations. PU reassessment was notably poor,as was the use of overall use of the BPURAT. Patient records lacked coherent entries and were in most cases very disorganised. Conclusion The majority of ‘at risk’ patients audited failed to receive the advocated PU care management. Records were significantly deficient and nursing staff appeared in some cases to lack sufficient training for the BPURAT and the assessment of PU. The standardised tool has not been implemented successfully for patients involved in this study. Communication amongst the multidisciplinary team appears insufficient in the majority of cases in relation to PUs and has hindered the management process of this ailment for those who require the highest level of care to prevent deterioration