Pressure ulcer risk assessment in long-term care nursing

The intent of this study was to determine whether the typical practice of using risk assessment tools in combination with the federally mandated Minimum Data Set (MDS) actually predict more cases of pressure ulcers (PUs) in long-term care facilities. Data in this study were collected from 555 resident charts in a sample of eight nursing homes. A total of 66 PUs were identified between September 1, 1996 and September 1, 1997 in a comparative test of the predictive abilities of the MDS versus the Braden Scale (BS) patient profiles. As shown by a Chi square test, the MDS and the BS assessment tools were valid in finding factors that placed residents in jeopardy of developing pressure ulcers: MDS chi 2 = 43.68, df = 1, p < .0001 and BS chi 2 = 52.47, df = 1, p < .001. However, a two-tailed t test, indicated results of the BS were significantly different than the MDS: t = 3.77, df = 97, p < .003 and BS = t = 3.77, df = 97, p < .001. Both the MDS and the BS identified patient factors: the MDS identified 311 at risk, resulting in accurate prediction of 62 of 66 PUs, while the BS found 172 at risk and predicted only 46 PUs accurately. Therefore, data indicate the BS did not make a significant difference in predicting the incidence of pressure ulcers in this sample of long-term care facilities. These unexpected findings would argue in favor of discontinuing the practice of using the BS for PU risk assessment simultaneously with the MDS, but rather at independent time frames such as immediately upon resident admission. This would continue to support the recommendations of the National Pressure Ulcer Advisory Panel (NPUAP), and at the same time, provide a more timely pressure ulcer risk assessment.