The evolution of a scale.

In children, most hospital-acquired pressure injuries are related to medical devices rather than immobility. A device that can’t be repositioned, such as this cast, presents additional risk. Photo by Rafael Ben-Ari/Alamy Stock Photo.

Pressure injury prevention has always been a top nursing priority. Do you know about the latest tool for early identification of pediatric patients at risk for pressure injury?

The well-known Braden Scale, developed in 1987, was followed in 1996 by the Braden Q Scale for use in kids. Both were developed by nurses and are widely used around the world. However, the Braden Q Scale focused on immobility as a risk factor and wasn’t designed to address device-related pressure injuries, risks to children younger than three weeks of age or older than eight years, or children with congenital heart disease.

An update to include device-related risk in children.

So Sandy Quigley and Martha Curley, the nurses who modified Braden and Bergstrom’s original Braden Scale, set out to validate an updated version of their pediatric tool in order to address medical device use, a broader age range, and children born with heart disease. In “How to Predict Pediatric Pressure Injury Risk with the Braden QD Scale” in this month’s AJN, they explore the use of their Braden QD Scale (the D is for device related).

Quigley, Curley, and colleagues emphasize that while immobility-related pressure injuries in children have decreased significantly, “[in pediatrics] most hospital-acquired pressure injuries are associated with the use of medical devices that are attached to or traverse the patient’s skin or mucus membranes.”

Seven subscales.

The Braden QD Scale reliably predicts both immobility-related and medical device–related pressure injuries in pediatric acute care. The authors explain how to assess risk using the seven subscales that make up the instrument, which include:

  • Mobility
  • Sensory perception
  • Friction and shear
  • Nutrition
  • Tissue perfusion and oxygenation
  • Number of medical devices
  • Device repositionability and/or skin protection used with device

Mini case studies to practice using the scale.

Several mini case studies included in the article present different scenarios that allow readers to practice using the Braden QD Scale. Read more about this essential tool in the November issue of AJN.