Supplementing the Braden scale for pressure ulcer risk among medical inpatients: the contribution of self-reported symptoms and standard laboratory tests

Abstract

Aims and objectives: To evaluate medical inpatients' symptom experience and selected laboratory blood results as indicators of their pressure ulcer risk as measured by the Braden scale.

Background: Pressure ulcers reduce quality of life and increase treatment costs. The prevalence of pressure ulcers is 6-23% in hospital populations, but literature suggests that most pressure ulcers are avoidable.

Design: Prospective, cross-sectional survey.

Methods: Three hundred and twenty-eight patients admitted to medical wards in an acute hospital in Oslo, Norway consented to participate. Data were collected on 10 days between 2012-2014 by registered nurses and nursing students. Pressure ulcer risk was assessed using the Braden scale, and scores <19 indicated pressure ulcer risk. Skin examinations were categorised as normal or stages I-IV using established definitions. Comorbidities were collected by self-report. Self-reported symptom occurrence and distress were measured with 15 items from the Memorial Symptom Assessment Scale, and pain was assessed using two numeric rating scales. Admission laboratory data were collected from medical records.

Results: Prevalence of pressure ulcers was 11·9, and 20·4% of patients were identified as being at risk for developing pressure ulcers. Multivariable analysis showed that pressure ulcer risk was positively associated with age ≥80 years, vomiting, severe pain at rest, urination problems, shortness of breath and low albumin and was negatively associated with nervousness.

Conclusion: Our study indicates that using patient-reported symptoms and standard laboratory results as supplemental indicators of pressure ulcer risk may improve identification of vulnerable patients, but replication of these findings in other study samples is needed.

Relevance to clinical practice: Nurses play a key role in preventing pressure ulcers during hospitalisation. A better understanding of the underlying mechanisms may improve the quality of care. Knowledge about symptoms associated with pressure ulcer risk may contribute to a faster clinical judgment of patients at risk.

Keywords: pressure ulcer; risk assessment; risk factors; symptoms and laboratory results.