# Improving Braden Scale Documentation for Pressure-Injury Risk Assessment: A Closed-Loop Clinical Audit at Dongola Specialized Hospital

## TL;DR

This study shows that targeted education and standardized tools can significantly improve Braden Scale documentation for pressure injury risk assessment in a hospital setting.

## Contribution

The study introduces a closed-loop clinical audit approach to improve Braden Scale documentation in a resource-limited hospital.

## Key findings

- Documentation of all six Braden subscales improved to near-universal completion after the intervention.
- Targeted education and standardized tools led to significant improvements in clinical risk assessment documentation.
- Administrative documentation fields showed declining completion rates after the intervention.

## Abstract

Background: Pressure injuries remain a significant and largely preventable cause of morbidity among hospitalized patients. Accurate and complete risk assessment using validated tools such as the Braden Scale is fundamental to effective prevention; however, documentation practices are often inconsistent, particularly in resource-limited settings.

Objective: To evaluate the completeness of Braden Scale documentation in the Internal Medicine Department at Dongola Specialized Hospital and to assess the impact of a targeted quality-improvement intervention through a closed-loop clinical audit.

Methods: A prospective closed-loop clinical audit was conducted over two cycles, each reviewing 51 patient records. Baseline documentation practices (Cycle 1) were assessed against predefined standards derived from international pressure-injury prevention guidelines. Following a structured two-month intervention comprising staff education, reinforcement of documentation expectations, and introduction of a standardized Braden documentation form, a second audit cycle (Cycle 2) was performed using identical criteria. Documentation completeness was analyzed using descriptive statistics, and differences between cycles were assessed using chi-square tests.

Results: At baseline, none of the Braden subscale scores, total scores, risk levels, or preventive actions were documented. Following the intervention, documentation of all six Braden subscales improved to near-universal completion (96.4-100%). Documentation of total Braden score, risk level, and preventive actions increased to 89.1%, 83.6%, and 89.1%, respectively (all p < 0.001). Significant improvements were also observed in consultant identification and bed number documentation. Conversely, completion rates for certain demographic fields, particularly hospital number and admission date, declined in Cycle 2.

Conclusion: This audit demonstrates that targeted education and standardized documentation tools can lead to substantial and statistically significant improvements in Braden Scale documentation. While clinical risk assessment practices improved markedly, persistent gaps in administrative documentation highlight the need for sustained monitoring and system-level reinforcement. Closed-loop clinical audits represent an effective strategy for strengthening pressure-injury risk assessment practices in hospital settings.