From the Guidelines
The Braden Scale should be used to assess patients for pressure ulcer risk, with scores of 18 or below indicating risk, and healthcare providers should implement preventive interventions based on the risk level, as recommended by the American College of Physicians guideline 1. The Braden Scale is a widely used risk assessment tool that evaluates six key factors: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. Each category is scored from 1 to 4 (except friction/shear, which is 1 to 3), with lower scores indicating higher risk. The total score ranges from 6 to 23.
- Patients scoring 18 or below are considered at risk for pressure ulcers, with risk levels categorized as:
- Mild risk (15-18)
- Moderate risk (13-14)
- High risk (10-12)
- Very high risk (9 or below) According to the American College of Physicians guideline, risk assessment is often part of bundled care and multicomponent interventions for preventing pressure ulcers, and clinicians should make individualized decisions based on risk assessment 1.
- Key components of successful implementation efforts include:
- Simplification and standardization of pressure ulcer–specific interventions and documentation
- Involvement of multidisciplinary teams and leadership
- Designated skin champions
- Ongoing staff education
- Sustained audit and feedback The use of the Braden Scale helps guide preventive interventions such as repositioning schedules, specialized support surfaces, and nutritional support based on risk level, as supported by moderate-quality evidence that advanced static mattresses and overlays were associated with a lower risk for pressure ulcers compared with standard mattresses in higher-risk patients 1.
From the Research
Braden Scale Scoring
- The Braden Scale is a tool used to assess the risk of pressure ulcers, with lower scores indicating a higher risk 2, 3, 4.
- The scale consists of several subscales, including mobility, activity, and sensory perception, which are used to calculate a total score 2, 4.
- A total Braden Scale score of 18 or less is generally considered to indicate a high risk of pressure ulcers, while a score above 18 indicates a lower risk 2.
Relationship Between Braden Scale Scores and Pressure Ulcer Risk
- Studies have shown that lower Braden Scale scores are associated with a higher incidence of pressure ulcers 2, 5, 3.
- For example, one study found that patients with a Braden Scale score of 15 or less had a significantly higher mortality rate than those with a score above 15 3.
- Another study found that patients with lower Braden Scale scores were more likely to develop pressure ulcers, particularly on the buttocks, sacrum, and coccyx 5.
Use of Braden Scale Scores in Pressure Ulcer Prevention Planning
- Braden Scale scores can be used to guide pressure ulcer prevention planning, with lower scores indicating a need for more intensive preventive interventions 2, 4.
- Nurses' selection of preventive interventions is influenced by Braden subscale ratings, with lower scores leading to a higher likelihood of endorsing certain interventions 4.
- However, the relationship between Braden Scale scores and pressure ulcer risk is not always straightforward, and other factors such as patient comorbidities and mobility must also be considered 6, 5.