# Improving Braden Scale Risk Assessment Documentation: A Two-Cycle Clinical Audit at Al-Managil Teaching Hospital, Sudan

## TL;DR

A hospital in Sudan improved Braden Scale documentation through education and standardization, leading to better patient risk assessments for pressure injuries.

## Contribution

Demonstrates effective low-cost interventions to improve Braden Scale documentation in resource-limited settings.

## Key findings

- Baseline documentation had 0% completion for all Braden components, but improved to 100% after intervention.
- Significant improvements were observed in subscale documentation, risk scoring, and action notes (p < 0.001).
- Educational and standardization interventions led to better patient identifiers and administrative field completion.

## Abstract

Background: Accurate Braden Scale documentation is essential for early identification of patients at risk for pressure injuries. Initial observations at Al-Managil Teaching Hospital in Al Managil, Sudan, indicated poor compliance with the Braden Scale assessment and documentation.

Objectives: To evaluate the completeness of Braden Scale documentation before and after a targeted educational and documentation-standardization intervention.

Methods: A closed-loop clinical audit was conducted in two cycles, each reviewing 51 patient records. Cycle 1 (retrospective) was performed on 16 May 2025. A two-month intervention consisting of staff education and implementation of a standardized Braden documentation form was introduced, followed by a prospective three-month Cycle 2. Data were analyzed using descriptive statistics and chi-square testing for documentation improvement.

Results: Baseline documentation was markedly incomplete, with 0% recording of all Braden subscales, total score, and risk level. After the intervention, Cycle 2 achieved 100% completion across all Braden components and significant improvements in patient identifiers and administrative fields (p < 0.001 for most parameters). The largest improvements were observed in subscale documentation, risk scoring, and action notes.

Conclusion: Targeted education combined with a standardized Braden Scale tool resulted in substantial and statistically significant improvements in documentation quality. These low-cost interventions can strengthen pressure-injury prevention practices in resource-limited settings. Continued monitoring and re-auditing are recommended to sustain compliance and assess clinical impact.