Braden QD Scale Notes

Braden QD Scale for Predicting Pressure Sore Risk

Introduction

  • The Braden QD Scale is utilized for assessing the risk of pressure sores in patients.

  • The assessment takes into account various factors related to the patient's mobility, sensory perception, skin integrity, nutritional status, tissue perfusion, oxygenation, and the use of medical devices.

Components of the Braden QD Scale

1. Intensity and Duration of Pressure

  • Mobility: The ability to independently change and control body position.

    • Score 0: No Limitation

    • Patient makes major and frequent changes in body or extremity position independently.

    • Score 1: Limited

    • Patient makes slight and infrequent changes OR is unable to reposition self independently (includes infants too young to roll over).

    • Score 2: Completely Immobile

    • Patient does not make any changes in body or extremity position independently.

2. Sensory Perception

  • Ability to Respond to Pressure-Related Discomfort: Ability to respond meaningfully and developmentally appropriately.

    • Score 0: No Impairment

    • Patient is responsive with no sensory deficits limiting the ability to feel or communicate discomfort.

    • Score 1: Limited

    • Patient cannot always communicate pressure-related discomfort or has some sensory deficits limiting the ability to feel discomfort.

    • Score 2: Completely Limited

    • Patient is unresponsive due to diminished consciousness or sedation, or sensory deficits limit the ability to feel discomfort across most of the body.

3. Tolerance of the Skin and Supporting Structure Friction & Shear

  • Definitions:

    • Friction: Occurs when skin moves against support surfaces.

    • Shear: Occurs when skin and adjacent bony surfaces slide against one another.

  • Score 0: No Problem

    • Patient can completely lift self during a move, maintaining good body position in bed or chair.

    • Score 1: Potential Problem

    • Patient requires some assistance in moving; occasionally slides down in bed or chair needing repositioning, which may cause skin sliding against surfaces.

    • Score 2: Problem

    • Patient requires full assistance; frequently slides down, making repositioning difficult without skin sliding against the surface. Conditions such as spasticity, contractures, itching, or agitation may lead to constant friction.

4. Nutrition

  • Diet Assessment: Assessment based on usual diet for age over the last 3 consecutive days.

    • Score 0: Adequate

    • Diet provides sufficient calories and protein to support metabolism and growth.

    • Score 1: Limited

    • Diet provides inadequate calories or protein, or patient receives supplemental nutrition at any part of the day.

    • Score 2: Poor

    • Diet provides inadequate calories and protein to support metabolism and growth.

5. Tissue Perfusion & Oxygenation

  • Assessment Parameters:

    • Normotensive for age, oxygen saturation greater than or equal to 95%, normal hemoglobin, capillary refill time of 2 seconds or less.

    • Score 0: Adequate

    • Values meet or exceed normal thresholds.

    • Score 1: Potential Problem

    • Oxygen saturation less than 95%, hemoglobin below 10 g/dl, or capillary refill greater than 2 seconds.

    • Score 2: Compromised

    • Patient hypotensive for age or hemodynamically unstable with position changes.

6. Medical Devices

  • Scoring: 1 point for each medical device up to a maximum of 8 points.

    • Any diagnostic or therapeutic device connected to or traversing the patient's skin or mucous membrane counts.

    • Score 0: No Medical Devices

    • Score 1: Potential Problem

    • All medical devices can be repositioned or the skin under each device is protected.

    • Score 2: Problem

    • One or more medical device(s) cannot be repositioned, or skin under each device is not protected.

7. Total Score

  • A total score of 13 or greater is considered at risk for pressure sore development.