Pressure ulcers (PUs) are one of the most frequent and preventable complications in hospitalized or mobility-limited patients. It is estimated that up to 95% of cases are avoidable with early risk assessment and appropriate preventive measures. The Braden Scale is the most widely used and validated tool worldwide for this purpose.
Developed in 1987 by Barbara Braden and Nancy Bergstrom, this scale evaluates six risk factors that directly contribute to the development of pressure ulcers. Its systematic application at hospital admission and on a periodic basis is a standard nursing practice worldwide.
The 6 Braden subscales
Each subscale is scored between 1 and 3 or 4 points. A low score in any subscale indicates greater risk.
1. Sensory perception (1–4)
Assesses the patient's ability to perceive and respond to pressure-related discomfort. Includes level of consciousness and ability to communicate pain. A score of 1 indicates a complete inability to perceive pain anywhere on the body.
2. Moisture (1–4)
Measures the degree of skin exposure to moisture (perspiration, incontinence, drainage). Moisture macerates the skin and makes it more susceptible to injury. A score of 1 means the skin is constantly moist.
3. Activity (1–4)
Evaluates the patient's degree of physical activity: from walking frequently (4) to being confined to bed (1). Immobility is one of the most significant risk factors for the development of PUs.
4. Mobility (1–4)
Assesses the patient's ability to independently change and control body position. Differs from activity in that a patient may be active but have limited mobility (e.g., with limb immobilization).
5. Nutrition (1–4)
Evaluates the patient's usual food intake pattern. Poor nutrition compromises skin integrity and regenerative capacity. A score of 1 indicates the patient is not eating or is on complete fasting.
6. Friction and shear (1–3)
Analyzes whether the patient slides on surfaces or requires assisted repositioning with dragging. Friction and shear damage the superficial layers of the skin. This subscale has only 3 points, not 4.
Total score and risk interpretation
| Total score | Risk level | Action |
|---|---|---|
| 6 – 9 | Very high risk | Immediate intensive prevention protocol |
| 10 – 12 | High risk | Active prevention protocol |
| 13 – 14 | Moderate risk | Standard preventive measures |
| 15 – 18 | Low risk | Monitoring and patient education |
| 19 – 23 | No apparent risk | Periodic reassessment |
Nursing interventions by risk level
Very high and high risk
- Repositioning every 2 hours (or more frequently if the situation requires it).
- Use of pressure-relieving support surfaces (viscoelastic mattresses, alternating pressure devices).
- Protection of bony prominences with prophylactic dressings (polyurethane foam).
- Intensive skin hydration, especially in high-risk areas (sacrum, heels, trochanters).
- Nutritional status optimization: consider protein supplements if needed.
- Strict control of incontinence and moisture.
Moderate risk
- Scheduled repositioning every 3–4 hours.
- Daily skin inspection, especially over bony prominences.
- Skin hydration and proper hygiene.
- Encourage active or assisted mobilization.
Low risk
- Patient and family education on positioning and mobilization.
- Periodic scale reassessment (at least every 72 hours or with clinical changes).
When to apply the Braden Scale?
International guidelines recommend applying it:
- At hospital admission for any patient with reduced mobility.
- Every 24–48 hours in high-risk patients or in the ICU.
- With any change in the patient's clinical status.
- At hospital discharge to plan home care.
Conclusion
The Braden Scale is a simple, validated, and high-impact clinical tool. Its systematic application allows early identification of at-risk patients and implementation of preventive measures before the injury develops. In nursing, preventing pressure ulcers is not just good practice — it is a quality of care indicator.