Tool and Resource Evaluation Template

Adapted by NARI from an evaluation template created by Melbourne Health. Some questions may not be applicable to every tool and resource.
Name and purpose Name of the resource: Braden Scale Author(s) of the resource: B. Braden and N. Bergstrom. Please state why the resource was developed and what gap it proposes to fill: Composed of six subscales: mobility, activity, sensory perception, skin moisture, nutritional status, and friction. Each subscale has its own operational definitions which are ranked from 1 (least favourable) to 3 or 4 (most favourable). Scores range from 6 to 23. The cut off point at which a patient is considered at risk is 16 points or less. Identification of individual risk factors is helpful in directing care. Target audience (the tool is to be used by) Please check all that apply: Health service users Medical staff Carers Nursing staff Any member of an interdisciplinary team

Medical specialist, please specify: Specific allied health staff, please specify: Other, please specify: Target population/setting (to be used on/in) Is the resource targeted for a specific setting? Please check all that apply: Emergency Department Other, please specify: For which particular health service users would you use this resource (e.g. a person with suspected cognitive impairment)? All in-patients in acute and subacute settings, or residential care settings. Structure of tool Website Pamphlet Methodology Education package Assessment tool Resource guide Video Screening tool Awareness raising resource (posters etc.) Inpatient acute Inpatient subacute Ambulatory

Other, please specify: Please state the size of the resource (e.g. number of pages, minutes to read): 1 page, usually printed in A4 Takes less than one minute to complete once the patient is assessed. Availability and cost of tool Is the resource readily available? Is there a cost for the resource? Yes Yes No No Unknown Unknown Not applicable Not applicable

Please state how to get the resource: This scale is provided below: BRADEN SCALE FOR PREDICTING PRESSURE SORE RISK The Braden Scale is also readily available via the internet and is recommended by the Australian Wound Management Association. Applicability to rural settings and culturally and linguistically diverse populations Is the resource suitable for use in rural health services (e.g. the necessary staff are usually available in rural settings)? Yes No Unknown Not applicable Is the resource available in different languages? Yes No Unknown Not applicable for use by staff

Is the content appropriate for different cultural groups? Yes No Unknown Not applicable

Person-centred principles Training

Does the resource adhere to/promote person-centred health care? Yes No Unknown Not applicable

Is additional training necessary to use the resource?

requirements

Yes

No

Unknown

Not applicable

If applicable, please state how extensive any training is, and what resources are required: Administration details How long does the resource take to use? 0-5 mins 5-15 mins 15-25mins 25mins +

Can the resource be used as a standalone, or must it be used in conjunction with other tools, resources, and procedures? Standalone Must be used with other resources, please specify: Can be used with other tools, please specify: Data collection and analysis Are additional resources required to collect and analyse data from the resource? Yes No Unknown Not applicable

If applicable, please state any special resources required (e.g. computer software): Sensitivity and specificity Sensitivity is the proportion of people that will be correctly identified by the tool. Specificity is the probability that an individual who does not have the condition being tested for will be correctly identified as negative. Has the sensitivity and specificity of the resource been reported? Yes No Unknown Not applicable If applicable, please state what has been reported: Initial studies reported 83 - 100% sensitivity and 64-90% specificity. In subsequent studies, sensitivity has ranged from 22 89% and specificity has ranged from 56 100% (Defloor & Grypdonck, 2004). Face Validity Does the resource appear to meet the intended purpose? Yes No Unknown Not applicable Reliability is the extent to which the tools measurements remain consistent over repeated tests of the same subject under identical conditions. Inter-rater reliability measures whether independent assessors will give similar scores under similar conditions. Has the reliability of the resource been reported? Yes No Unknown Not applicable If applicable, please state what has been reported: Percentage agreement of up to 88% was achieved and correlational measures of reliability were excellent when used by a registered nurse (r = 0.99). However, Raycroft-Malone (2000) argues that the reliability has not been properly assessed. Bergstrom and Braden recommended that that registered nurses use the tool. Scores less reliable when the tool was used by less qualified staff. Strengths What are the strengths of the resource? Is the resource easy to understand and use? Are instructions provided on how to use the resource? Is the resource visually well presented (images, colour, font type/ size)? Does the resource use older friendly terminology (where relevant), avoiding jargon? Please state any other known strengths, using dot points: User friendly and quick. Reliable when used by nursing staff. In common usage in Australia and USA. Validity compares well with Norton and Waterlow scales. Limitations What are the limitations of the tool/resource? Is the tool/resource difficult to understand and use? Are instructions provided on how to use the tool/resource? Is the tool/resource poorly presented (images, colour, font type/ size)? Does the tool/resource use difficult to understand jargon? Please state any other known limitations, using dot points: Reliability is reduced when not used by nursing staff. Experienced nurses should conduct the risk assessment (Papanikolaou et al., 2007). Critical cut-off score is disputable (Papanikolaou et al., 2007). References and further reading Supporting references and associated reading. 1. Australian Wound Management Association Clinical Practice Guidelines for the prediction

Reliability

2. 3. 4. 5. 6.

and prevention of pressure ulcers. Available at: http://www.awma.com.au/publications/2007/cpgpppu_v_full.pdf Health Services Technology Assessment Test - National Library of Medicine. http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat2.chapter.4409 Braden B & Bergstrom N. A conceptual scheme for the study of etiology of pressure sores. Rehabilitation Nursing. 1987;12:8-16. Defloor T & Grypdonck M. Validation of pressure ulcer risk assessment scales: a critique. Journal of Advanced Nursing. 2004;48:613-621. Papanikolaou P, Lyne P & Anthony D. Risk assessment scales for pressure ulcers: A methodological review. International Journal of Nursing Studies, 2007;44:285-296. Raycroft-Malone J. Pressure ulcer risk assessment and prevention. Technical reporting. 2000 RCN Publishing, London.

BRADEN SCALE FOR PREDICTING PRESSURE SORE RISK

Patient=s Name _____________________________________ SENSORY PERCEPTION ability to respond meaningfully to pressure-related discomfort 1. Completely Limited Unresponsive (does not moan, flinch, or grasp) to painful stimuli, due to diminished level of con-sciousness or sedation. OR limited ability to feel pain over most of body Evaluator=s Name________________________________ 2. Very Limited Responds only to painful stimuli. Cannot communicate discomfort except by moaning or restlessness OR has a sensory impairment which limits the ability to feel pain or discomfort over 2 of body. 3. Slightly Limited Responds to verbal commands, but cannot always communicate discomfort or the need to be turned. OR has some sensory impairment which limits ability to feel pain or discomfort in 1 or 2 extremities. Date of Assessment 4. No Impairment Responds to verbal commands. Has no sensory deficit which would limit ability to feel or voice pain or discomfort..

MOISTURE degree to which skin is exposed to moisture

1. Constantly Moist Skin is kept moist almost constantly by perspiration, urine, etc. Dampness is detected every time patient is moved or turned. 1. Bedfast Confined to bed.

2. Very Moist Skin is often, but not always moist. Linen must be changed at least once a shift.

3. Occasionally Moist: Skin is occasionally moist, requiring an extra linen change approximately once a day.

4. Rarely Moist Skin is usually dry, linen only requires changing at routine intervals.

ACTIVITY degree of physical activity

2. Chairfast Ability to walk severely limited or non-existent. Cannot bear own weight and/or must be assisted into chair or wheelchair. 2. Very Limited Makes occasional slight changes in body or extremity position but unable to make frequent or significant changes independently. 2. Probably Inadequate Rarely eats a complete meal and generally eats only about 2 of any food offered. Protein intake includes only 3 servings of meat or dairy products per day. Occasionally will take a dietary supplement. OR receives less than optimum amount of liquid diet or tube feeding

3. Walks Occasionally Walks occasionally during day, but for very short distances, with or without assistance. Spends majority of each shift in bed or chair 3. Slightly Limited Makes frequent though slight changes in body or extremity position independently.

4. Walks Frequently Walks outside room at least twice a day and inside room at least once every two hours during waking hours 4. No Limitation Makes major and frequent changes in position without assistance.

MOBILITY ability to change and control body position

1. Completely Immobile Does not make even slight changes in body or extremity position without assistance

NUTRITION usual food intake pattern

1. Very Poor Never eats a complete meal. Rarely eats more than a of any food offered. Eats 2 servings or less of protein (meat or dairy products) per day. Takes fluids poorly. Does not take a liquid dietary supplement OR is NPO and/or maintained on clear liquids or IV=s for more than 5 days. 1. Problem Requires moderate to maximum assistance in moving. Complete lifting without sliding against sheets is impossible. Frequently slides down in bed or chair, requiring frequent repositioning with maximum assistance. Spasticity, contractures or agitation leads to almost constant friction

3. Adequate Eats over half of most meals. Eats a total of 4 servings of protein (meat, dairy products per day. Occasionally will refuse a meal, but will usually take a supplement when offered OR is on a tube feeding or TPN regimen which probably meets most of nutritional needs

4. Excellent Eats most of every meal. Never refuses a meal. Usually eats a total of 4 or more servings of meat and dairy products. Occasionally eats between meals. Does not require supplementation.

FRICTION & SHEAR

2. Potential Problem Moves feebly or requires minimum assistance. During a move skin probably slides to some extent against sheets, chair, restraints or other devices. Maintains relatively good position in chair or bed most of the time but occasionally slides down.

3. No Apparent Problem Moves in bed and in chair independently and has sufficient muscle strength to lift up completely during move. Maintains good position in bed or chair.

8 Copyright Barbara Braden and Nancy Bergstrom, 1988 All rights reserved

Total Score