Braden Q score
The best treatment for pressure ulcers is prevention! Prevention starts with detecting patients at high risk.
The Braden Q scale is a tool used to assess patients for risk of skin breakdown. Seven risk factors are assessed and are given a rating 0-4 and the individual ratings are totaled. The highest possible score is 28, meaning the patient is not at any risk for skin breakdown; the lower the number, the higher the risk. The seven risk factors are: mobility, activity, sensory perception, moisture, friction/shear, nutrition, and tissue perfusion and oxygenation. A score <17 indicates a high risk for pressure-related injury. The Braden Q score alerts us to patients who need prophylaxis for pressure ulcers, such as a mattress pump, specialty bed and/ or mattress, foam dressings to pad bony prominences, and use of turning and/ or positioning devices.
Prevention methods should be implemented 24 hours/ day, 7 days/ week. Interventions may decrease the size of the wound, as well as the duration of healing.
*The Braden Q scale is not considered an accurate assessment tool for infants < 1 year of age.
Beds
Your patient may benefit from a specialty bed, depending on your assessment of the patient, including their score from the Braden scale. There are two types/ groups of mattress systems, both designed to distribute weight and pressure more evenly. We go through several companies and use several kinds of beds. Types of beds:
1) Static-pressure-redistributing: These include foam and air mattresses and are designed to assume the shape consisted with the weight, or pressure exerted into the bed.
2) Dynamic-pressure-redistributing: Electrically driven and change by external factors, such as air pumps. The most important of the dynamic group are the "air-fluidized" beds and "low air-loss systems."
We carry mattress overlays, which wick moisture from the patient and decrease shearing. I addition to the beds listed in the algorithm we use the Dolphin bed, which simulates fluid immersion. |
Other Prevention Measures:
Repositioning: It is important to redistribute the pressure at least every 2 hours. If the patient is on a pressure-redistributing mattress system, repositioning may be perfomed every 4 hours minimum. Pressure is lowest when the patient lies in semi-fowler position with the head of bed and foot of the bed raised to 30 degrees.
Cushion Systems: Several varieties of products exist: foam, gel, foam and gel, hollow-fiber, water cushions, and sheepskin. Monitor the patient for the "bottoming-out" effect, where the buttocks comes in contact with the chair, bed frame, or other surface on which the patient is sitting. The hospital stocks gel pillows. We, Wound Team, stock fluidized positioning pillows, z-flo pillows.
"Float" heels: Keep heels from being directly on the bed/ mattress by placing pillow(s) under the patients knees and/ or cushioning devices directly under the heels.