Utilizing the Braden Scale

• One of the most effective ways to perform an accurate skin assessment is to use the Braden Scale that assists in determining whether an individual is at an increased risk for pressure injury development 
• The Braden Scale should be utilized each time a patient is admitted and then once daily or more often if there is a significant change in the condition of the patient’s skin.  
• Due to the shown effectiveness of the Braden Scale, the scale has proven to be both useful and reliable in decreasing the risks for pressure ulcer development by utilizing careful implementation through assessment and scoring factors. Learn more about using the Braden Scale to improve patient care. 

Assessing a patient’s skin is important for nurses that are working immensely to alleviate pressure ulcers and other areas of skin breakdown.  One of the most effective ways to perform an accurate skin assessment is to use the Braden Scale that assists in determining whether an individual is at an increased risk for pressure injury development.   

The tool is evidence-based and was developed by Nancy Braden and Barbara Bergstrom and is used to predict the risk of developing a hospital or facility-acquired pressure ulcer or injury. 

Many pressure ulcers can be prevented. It is important for nurses to assess the skin thoroughly for any susceptible high-risk areas in order to optimize treatment for the patient. 

Organization of The Braden Scale

Nurses may ask how is the Braden Scale organized and how one can use it within his/her work environment.  The scale is organized into six categories and are assessed thoroughly each time the Braden Scale is utilized: 

• Sensory Perception – focuses on the ability to respond to meaningful pressure-related discomfort 
• Moisture – refers to the degree in which the skin is exposed to moisture 
• Activity – refers to the degree of physical activity present with the patient 
• Mobility – focuses on the ability to change and control one’s body position  
• Nutrition – focuses on the usual food intake pattern of the patient  
• Friction and shear – focuses on the presence of these specific factors involving the skin 
  

The Braden Scale should be utilized each time a patient is admitted and then once daily or more often if there is a significant change in the condition of the patient’s skin.  It is imperative to assess intently as changes within the skin can happen rapidly especially in acute care settings.

Scoring of the Braden Scale

The scoring of the Braden Scale uses scores from less than or equal to 9 to as high as 23.  It is important to note that the lower the number, the greater the risk for developing an acquired pressure ulcer or injury.  The following is a breakdown of the scores: 

19-23 = No Risk 

15-18 = Mild Risk 

13-14 = Moderate Risk 

Less than 9 = Severe Risk  

Once the skin assessment is complete, the nurse will tally the total numbers and a final score will be given.  If any changes are noted or take place during a patient’s admission, the scores may change, and it is the nurse’s responsibility to assess these changes and to document accurately.   

Even though the total scores are documented, it is crucial for the nurse to verbally communicate any changes to the oncoming nurse and medical provider to remain proactive regarding any worsening skin conditions.  

Effectiveness of the Braden Scale

The Braden Scale has proven to be highly effective in assessing the risks for hospital acquired pressure ulcers (HAPU) among patients in medical, surgical, and critical care settings. It has proven to be more accurate than relying only on the clinical judgment of nurses.   

The reliability of the scale among nurses has also proven to be effective with an interrater reliability ranging from 0.83-0.99, with percent agreement ranging from 88%-100%.  The sensitivity of the Braden Scale ranges from 61%-100% and the specificity ranges from 26%-100%.   

The results indicated that Braden Scores on Day 7 were predictive of pressure ulcer development within a 2-week period of hospitalization.  Nutrition screening factors, pressure ulcer development, and low body mass index also showed a significant relationship among sacral ulcer development.   

Due to the shown effectiveness of the Braden Scale, the scale has proven to be both useful and reliable in decreasing the risks for pressure ulcer development by utilizing careful implementation through assessment and scoring factors. 

The Braden Scale has a moderate predictive validity for pressure ulcer risk assessment and has been found to be more suitable for the mean age of <60 years, hospitalized patients, and the Caucasion population.   

The Braden Scale has proven to accurately assess patients at risk, as well as those not at risk.  With the Braden Scale covering six common risk factor areas, it has been proven to be the most effective in detecting the potential of pressure ulcers and has served as a great tool to intervene quickly in providing proactive treatment.  

The Bottom Line

Since pressure ulcers are a global problem affecting many patients in acute care settings that  can cause increased pain and infection, it is of utmost importance that nurses and practitioners correctly identify the risks of pressure ulcers in order for prompt and effective interventions to be initiated.   

With the increased link to mortality that has been associated with pressure ulcers, it is a necessity that an assessment tool such as the Braden Score be identified, utilized, and reviewed since many pressure ulcers can be preventable if accurate assessments are being conducted in a timely manner.

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