The Braden Scale: Scoring Pressure Injury Risk, and Actually Acting on It

Pressure injuries are among the clearest examples of harm that nursing care prevents outright. They’re also among the most reliably predictable, which is why a risk score exists at all.

The Braden Scale is the most widely used of those scores. It works — but only when the number leads somewhere. A Braden charted on admission and never converted into an intervention is documentation, not prevention.

The six subscales

Each is scored 1 to 4, except friction and shear which runs 1 to 3. Totals range from 6 to 23, and — counterintuitively — lower means higher risk.

Subscale	What it asks	Range
Sensory perception	Can they feel and report discomfort?	1–4
Moisture	How wet is the skin kept?	1–4
Activity	How much do they move about?	1–4
Mobility	Can they reposition themselves?	1–4
Nutrition	What are they actually eating?	1–4
Friction & shear	Do they drag across surfaces when moved?	1–3

The risk bands

Thresholds vary a little between institutions, so follow your facility’s protocol. Commonly:

Total	Risk
19–23	Not at risk
15–18	Mild
13–14	Moderate
10–12	High
9 or below	Very high

The part that actually matters: subscale-driven care

Here’s the most useful thing to understand about the Braden — the total tells you how worried to be, but the subscales tell you what to do. Two patients can both score 13 for completely different reasons and need completely different plans.

• Low sensory perception — they won’t tell you it hurts, so the schedule has to do the work. Scheduled repositioning, deliberate inspection of pressure points, and extra attention to anything they can’t feel: heels, sacrum, under devices.
• Low moisture — incontinence, sweat, or drainage is macerating skin. Barrier products, absorbent surfaces that wick rather than trap, and prompt changes. Moisture-damaged skin breaks down under far less pressure.
• Low activity or mobility — the core of most plans. A repositioning schedule that’s actually followed, pressure-redistributing surfaces, heel offloading, and getting them up when it’s safe. Mobility is the subscale most responsive to nursing effort.
• Low nutrition — protein and calories are what tissue repairs with. This is a dietitian referral, not a note. Track intake honestly.
• Low friction and shear — the fix is technique and equipment: lift rather than drag, use a slide sheet, limit head-of-bed elevation where the clinical picture allows, because a patient sliding down the bed is shearing every time.

Timing and reassessment

Score on admission, and then on your facility’s schedule — often each shift in higher-acuity settings and less often in stable ones. What matters more than the interval is rescoring when the patient changes: after surgery, a new vasopressor, sedation, a fall in intake, new incontinence, or a transfer between units.

Risk isn’t static. A patient admitted independently ambulant and scoring 20 can be a 12 three days later, and nobody notices unless somebody rescores.

The bottom line

The Braden is a good scale used carelessly more often than not. Score it honestly, read the subscales rather than only the total, and let each low subscale name its own intervention. The number’s only purpose is to change what you do next.

Try it

Score all six subscales with the Braden Scale calculator — it totals them and flags the risk band.

Keep going

For the patient whose vital signs are drifting rather than their skin, early warning scores covers the other end of proactive monitoring.

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