The Origins and Purpose of the Braden Score Chart
Developed in the 1980s by nurses Barbara Braden and Nancy Bergstrom, the Braden Scale for Predicting Pressure Sore Risk is now the most widely used pressure injury risk assessment tool in the United States. Its purpose is to provide a standardized, objective method for healthcare professionals to identify patients at a heightened risk for skin breakdown. By evaluating a patient's risk upon admission and throughout their stay, clinicians can proactively put preventative measures into place before a pressure ulcer develops. This early intervention is critical, as pressure injuries can lead to serious complications and prolonged hospital stays.
The Six Subscales of the Braden Score
The Braden scale is based on six subscales that represent common risk factors for developing pressure injuries. Each category is assigned a numerical score, with lower scores indicating greater impairment and higher risk. The subscales are:
- Sensory Perception: This assesses a patient's ability to respond meaningfully to pressure-related discomfort. A patient who is sedated or has neurological impairments may not be able to feel or communicate pain, putting them at higher risk.
- Moisture: This evaluates the degree to which a patient's skin is exposed to moisture, such as from perspiration, urine, or wound drainage. Prolonged moisture exposure can increase the risk of skin breakdown.
- Activity: This measures the patient's level of physical activity. A patient who is confined to a bed (
bedfast) has a significantly higher risk than one who walks frequently. - Mobility: This determines the patient's ability to change and control their body position independently. Patients who are completely immobile need frequent assistance to avoid sustained pressure on bony prominences.
- Nutrition: This assesses the patient's usual food intake pattern. Adequate nutrition is vital for skin integrity and wound healing. A patient with very poor intake is at a higher risk.
- Friction and Shear: This measures the amount of assistance a patient needs when being moved. Friction occurs when two surfaces rub together, while shear is the force of skin sliding in the opposite direction of the bone. Both can damage the skin's top layers. This subscale is unique as it is scored from 1 to 3, rather than 1 to 4.
Interpreting the Braden Score and Corresponding Risk Levels
The scores from the six subscales are summed to produce a total score ranging from 6 to 23. The total score falls into specific risk categories, which inform the level of preventative care required. A lower score indicates a higher risk of pressure ulcer development.
| Total Score Range | Risk Level | Interpretation |
|---|---|---|
| 19–23 | Low Risk | Unlikely to develop a pressure injury, but monitoring is still important. |
| 15–18 | Mild Risk | Requires mild preventative interventions, such as skin hygiene education. |
| 13–14 | Moderate Risk | Requires education on positioning, skin health, and repositioning intervals. |
| 10–12 | High Risk | Needs more in-depth education and potentially extra equipment, like special mattresses. |
| 9 or less | Severe Risk | Patients are at very high risk and require frequent monitoring and aggressive prevention protocols. |
How the Braden Score Informs Patient Care
Identifying a patient's risk level with the Braden score is not an end in itself but rather a starting point for developing a personalized care plan. For example, a patient with a low score in the 'Moisture' category might require more frequent linen changes and skin barrier creams. A low score in 'Mobility' would prompt a stricter schedule for repositioning and turning the patient.
- Targeted Interventions: The score on each subscale helps pinpoint specific problem areas, allowing nurses to tailor interventions effectively.
- Regular Reassessment: A patient's condition can change over time. The Braden scale is designed to be used repeatedly, often upon admission and at routine intervals, to ensure the care plan remains appropriate.
- Preventative Equipment: For high-risk patients, the score might necessitate the use of specialized beds, pressure-reducing mattresses, or other devices to minimize pressure on vulnerable areas.
For more detailed information on preventing pressure injuries, refer to the Agency for Healthcare Research and Quality.
Comparison: Braden Scale vs. Waterlow Scale
While the Braden scale is widely used in the US, other tools like the Waterlow scale exist. It's useful to understand their differences.
| Feature | Braden Scale | Waterlow Scale |
|---|---|---|
| Number of Subscales | Six (Sensory Perception, Moisture, Activity, Mobility, Nutrition, Friction/Shear). | Eleven (BMI, skin condition, sex, age, nutrition, continence, mobility, neurological deficit, surgery/trauma, medication). |
| Total Score Range | 6 to 23. | 5 to 20 or other ranges depending on items used. |
| Interpretation | Lower score indicates higher risk. | Higher score indicates greater risk. |
| Assessment Items | Focused on physical condition and functional abilities related to pressure. | Includes more comprehensive patient history, comorbidities, and medications. |
| Use Case | Most frequently used in the US, especially in hospitals and critical care. | Validated and used in many settings, sometimes considered more comprehensive. |
Conclusion: The Enduring Importance of the Braden Score
The Braden score chart is a cornerstone of preventative nursing care, offering a clear, standardized, and evidence-based approach to assessing and mitigating pressure ulcer risk. Its continued widespread use underscores its effectiveness in patient safety, helping healthcare teams identify vulnerabilities and implement targeted interventions to protect fragile skin. By leveraging the six risk factors identified by the scale, medical professionals can empower themselves to provide proactive, individualized care, leading to improved patient outcomes and a reduction in preventable pressure injuries.
