Braden Scale and Restraints: Assessing Pressure Injury Risk

The Braden Scale and Restraints

The Braden Scale is a widely recognized tool used to assess an individual's risk for pressure injuries, or bedsores, in various healthcare settings. Developed by Dr. Braden and colleagues in 1987, this valuable resource extends its usefulness to consider another aspect of patient care: the use of restraints.

Restraints, often used to prevent patients from injuring themselves or others, can significantly increase a patient's risk of developing pressure injuries. The Braden Scale is not a specific tool for assessing restraints, but it can help healthcare providers identify vulnerabilities, like pressure injury risk, which may make the use of restraints necessary in certain cases.

Restraints and Pressure Injury Risk

Restraints can lead to several consequences that contribute to pressure injury risk.

1. Impaired mobility: Restraints limit a patient's ability to reposition themselves, which is crucial for preventing pressure injuries. When patients cannot move or shift their weight regularly, areas of the body subjected to prolonged pressure are more likely to develop sores.
2. Pressure offloading disruptions: Restraints can prevent patients from shifting their body weight or redistribute pressure, which is a fundamental strategy to reduce pressure injury risk.
3. Reduced blood circulation: Tight or incorrectly placed restraints may impair blood circulation, which can increase the risk of tissue damage and pressure injuries.

Assessing Restraint Risk with the Braden Scale

The Braden Scale, although not explicitly designed to address restraints, provides a comprehensive assessment of the risk factors that can facilitate the use of restraints. In turn, this helps healthcare providers identify these risk factors and consider alternative approaches to minimize restraint use while still ensuring patient safety.

Some Braden Scale subcategories that impact the restraint risk assessment include:

1. Sensory perception: Patients with impaired sensory perception may not be able to feel pressure or pain, which can increase their risk of developing pressure injuries. They may also need restraints to prevent self-harm or injury.
2. Mobility: As mentioned earlier, patients with mobility limitations are more likely to develop pressure injuries due to their inability to reposition themselves and redistribute pressure.
3. Fragility: Fragile patients, like the elderly or those with compromised health, are more likely to develop pressure injuries. In such cases, restraints may be necessary to prevent falls or self-harm.

Best Practices for Restraint Use with the Braden Scale

When using restraints, healthcare providers should consider the following:

1. Maximize patient safety: Restraints should be used only when necessary to prevent harm to the patient or others.
2. Minimize pressure injury risk: Healthcare providers should assess patient vulnerabilities using the Braden Scale to determine if restraints may increase the risk of developing pressure injuries.
3. Promote patient mobility: Encourage patients to reposition themselves and participate in preventative measures to reduce pressure injury risk.

In conclusion, the Braden Scale is a valuable tool that helps healthcare providers identify the risk factors for pressure injuries and restraint use. By considering the interplay of these factors, healthcare providers can make informed decisions to promote patient safety and minimize pressure injury risk.