Charting Q2 Turns/Activity A standard of care that should be performed and documented for all patients who have braden scores less than 18.

Welcome to this Presentation! Thanks for completing this PowerPoint about the importance of performing and documenting activity on all patients who have Braden Scores less than 18. This is a hospital-wide standard of care. Studies show that frequent repositioning and activity for patients with low Braden Scores can prevent hospital-acquired pressure injuries (HAPIs) and skin breakdown. This presentation will explain why this standard of care is important. This presentation will also provide information on Braden Scores and charting activity for patients.

Why is this a big deal? When a patient develops a pressure injury they are: 7.9% more likely to die during their hospital stay. 10.9% more likely to die within 30 days of discharge. 5% more likely to be readmitted within 30 days of discharge. On average, a hospital-acquired pressure injury increases a patient’s hospital stay by 6.4 days. No other preventable complication occurs as frequently as pressure injuries.

What is a Braden Score? The Braden Scale is a nursing tool used to indicate a patient’s risk for developing a pressure injury. The scale ranges from 6 (most at risk) to 23 (least at risk). The 6 subscales include: Sensory Perception, Activity Status, Nutrition, Moisture, Mobility, and Friction & Shear. Per our hospital’s standard, if your patient has a Braden Score less than 18, they are considered “at risk” for developing a pressure injury and must have interventions in place to prevent pressure injuries.

Where do I chart a Braden Score? Nurses chart Braden Scores under the “Adult Skin” band in iView. All drop-down subscales of the Braden Skin Risk Assessment must be charted for a Braden Score to be calculated. If your patient has a Braden Score less than 18, they are considered “at risk” for developing a pressure injury.

What if I’m not sure what to chart on a subscale? If you are unsure what to chart on a subscale of the Braden Skin Risk Assessment, there is a Reference Text option available in iView. Hover your mouse over “Braden Skin Score” and click the hyperlink “Reference Text”.

Braden Scale/Skin Risk Score Informational Reference Card

Charting Activity/Turns If a patient has a Braden Score less than 18, activity must be charted every two hours. Hospital Acquired Pressure Injuries (HAPIs) can be prevented by frequent repositioning and activity. It is ultimately the nurse’s responsibility to ensure that activity/turns are being performed and charted every two hours. Get your tech engaged, but know it is your responsibility to make sure it is done and charted!

What do I do if the patient refuses to be repositioned? Provide rationale on importance of repositioning to prevent pressure injuries (remember to use words your patient understands!) Document they refused (with the reason why). Go up the chain! If the patient is refusing, notify the resource nurse  SLS  nurse clinicians  intern. Talk about the refusal during bedside report and during MD rounds. Please document who you notified about the patient’s refusal.

Legal Consequences for a HAPI While a patient may threaten you with litigation when you ask them to reposition, remember this: The cost of a full thickness pressure injury: $43,180* The cost of a Stage 4 pressure injury: $127,185* Awards are much lower if a patient gets a pressure injury and the guidelines were followed (turns q2, measuring and charting). When the cost of claims are considered, the cost of prevention is substantially lower than the treatment. *on average in 2007.