Braden Scale Form PDF Details

In this post, the author discusses the Braden Scale Form. The scale is a questionnaire with a series of questions in order to identify any underlying medical conditions in patients who are experiencing symptoms such as fatigue and weight loss. These symptoms can be signs of an underlying disease or condition. The author also lists down some factors that should be considered before using the Braden Scale form for assessment purposes. The Braden Scale Form is a questionnaire used by doctors to assess whether your patient may have an underlying medical condition affecting their health. In this blog post, I will discuss how you can use the scale effectively during diagnosis and what factors need to be taken into account beforehand so that it doesn't lead to inaccurate results or delays in treatment when needed most.

This table features specifics of braden scale form. Our recommendation is that you look at this information before you decide to start filling out the file.

QuestionAnswer
Form NameBraden Scale Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesprintable braden scale, braden score chart, fillable braden, braden scale pdf

Form Preview Example

BRADEN SCALE – For Predicting Pressure Sore Risk

 

SEVERE RISK: Total score 9

HIGH RISK: Total score 10-12

DATE OF

 

MODERATE RISK: Total score 13-14

MILD RISK: Total score 15-18

ASSESS

 

 

 

 

 

 

 

 

RISK FACTOR

 

 

 

 

 

SCORE/DESCRIPTION

 

 

 

 

 

 

 

1

2

3

4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SENSORY

 

 

 

1. COMPLETELY

2. VERY LIMITED

3. SLIGHTLY LIMITED

 

4. NO IMPAIRMENT

 

 

 

 

 

PERCEPTION

 

 

 

LIMITED – Unresponsive

Responds only to painful

Responds to verbal

 

 

Responds to verbal

 

 

 

 

 

Ability to respond

 

 

(does not moan, flinch, or

stimuli. Cannot

commands but cannot

 

 

commands. Has no

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

meaningfully to

 

 

 

grasp) to painful stimuli,

communicate discomfort

always communicate

 

 

sensory deficit which

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

pressure-related

 

 

due to diminished level of

except by moaning or

discomfort or need to be

 

would limit ability to feel

 

 

 

 

 

 

discomfort

 

 

 

consciousness or

restlessness,

turned,

 

 

or voice pain or

 

 

 

 

 

 

 

 

 

 

 

sedation,

OR

 

OR

 

 

discomfort.

 

 

 

 

 

 

 

 

 

 

 

 

OR

has a sensory impairment

has some sensory

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

limited ability to feel pain

which limits the ability to

impairment which limits

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

over most of body

feel pain or discomfort

ability to feel pain or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

surface.

over ½ of body.

discomfort in 1 or 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

extremities.

 

 

 

 

 

 

 

 

 

 

 

 

 

MOISTURE

 

 

 

1. CONSTANTLY

2. OFTEN MOIST – Skin

3. OCCASIONALLY

 

 

4. RARELY MOIST – Skin

 

 

 

 

 

Degree to which

 

 

 

MOIST– Skin is kept

is often but not always

MOIST – Skin is

 

 

is usually dry; linen only

 

 

 

 

 

skin is exposed to

 

 

moist almost constantly

moist. Linen must be

occasionally moist,

 

 

requires changing at

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

moisture

 

 

 

by perspiration, urine,

changed at least once a

requiring an extra linen

 

 

routine intervals.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

etc. Dampness is detected

shift.

change approximately

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

every time patient is

 

once a day.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

moved or turned.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ACTIVITY

 

 

 

1. BEDFAST – Confined

2. CHAIRFAST – Ability

3. WALKS

 

 

4. WALKS

 

 

 

 

 

Degree of physical

 

 

to bed.

to walk severely limited

OCCASIONALLY – Walks

 

FREQUENTLY– Walks

 

 

 

 

 

activity

 

 

 

 

 

 

or nonexistent. Cannot

occasionally during day,

 

outside the room at least

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

bear own weight and/or

but for very short

 

 

twice a day and inside

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

must be assisted into

distances, with or without

 

room at least once every

 

 

 

 

 

 

 

 

 

 

 

 

 

 

chair or wheelchair.

assistance. Spends

 

 

2 hours during waking

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

majority of each shift in

 

hours.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

bed or chair.

 

 

 

 

 

 

 

 

 

 

 

 

 

MOBILITY

 

 

 

1. COMPLETELY

2. VERY LIMITED

3. SLIGHTLY LIMITED

 

4. NO LIMITATIONS

 

 

 

 

 

Ability to change

 

 

IMMOBILE – Does not

Makes occasional slight

Makes frequent though

 

Makes major and

 

 

 

 

 

and control body

 

 

make even slight changes

changes in body or

slight changes in body or

 

frequent changes in

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

position

 

 

 

in body or extremity

extremity position but

extremity position

 

 

position without

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

position without

unable to make frequent

independently.

 

 

assistance.

 

 

 

 

 

 

 

 

 

 

 

assistance.

or significant changes

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

independently.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NUTRITION

 

 

 

1. VERY POOR – Never

2. PROBABLY

3. ADEQUATE – Eats

 

 

4. EXCELLENT – Eats

 

 

 

 

 

Usual food intake

 

 

eats a complete meal.

INADEQUATE – Rarely

over half of most meals.

 

most of every meal.

 

 

 

 

 

pattern

 

 

 

Rarely eats more than 1/3

eats a complete meal and

Eats a total of 4 servings

 

Never refuses a meal.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1NPO: Nothing by

 

 

of any food offered. Eats

generally eats only about

of protein (meat, dairy

 

 

Usually eats a total of 4 or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2 servings or less of

½ of any food offered.

products) each day.

 

 

more servings of meat

 

 

 

 

 

 

mouth.

 

 

 

protein (meat or dairy

Protein intake includes

Occasionally refuses a

 

 

and dairy products.

 

 

 

 

 

 

2IV: Intravenously.

 

 

products) per day. Takes

only 3 servings of meat or

meal, but will usually take

 

Occasionally eats

 

 

 

 

 

 

3TPN: Total

 

 

 

fluids poorly. Does not

dairy products per day.

a supplement if offered,

 

between meals. Does not

 

 

 

 

 

 

parenteral

 

 

 

take a liquid dietary

Occasionally will take a

 

OR

 

 

require supplementation.

 

 

 

 

 

 

nutrition.

 

 

 

supplement,

dietary supplement

is on a tube feeding or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OR

OR

TPN3 regimen, which

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

is NPO1 and/or

receives less than

probably meets most of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

maintained on clear

optimum amount of

nutritional needs.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

liquids or IV2 for more

liquid diet or tube

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

than 5 days.

feeding.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FRICTION AND

 

 

1. PROBLEM- Requires

2. POTENTIAL

3. NO APPARENT

 

 

 

 

 

 

 

 

 

 

 

 

 

SHEAR

 

 

 

moderate to maximum

PROBLEM– Moves

PROBLEM – Moves in

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

assistance in moving.

 

feebly or requires

bed and in chair

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete lifting without

 

minimum assistance.

independently and has

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

sliding against sheets is

 

During a move, skin

sufficient muscle strength

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

impossible. Frequently

 

probably slides to some

to lift up completely

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

slides down in bed or

 

extent against sheets,

during move. Maintains

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

chair, requiring frequent

 

chair, restraints, or other

good position in bed or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

repositioning with

 

devices. Maintains

chair at all times.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

maximum assistance.

 

relatively good position in

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Spasticity, contractures,

 

chair or bed most of the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

or agitation leads to

 

time but occasionally

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

almost constant friction.

 

slides down.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL

 

 

 

 

Total score of 12 or less represents HIGH RISK

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SCORE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ASSESS

 

DATE

 

EVALUATOR SIGNATURE/TITLE

 

ASSESS.

 

DATE

 

EVALUATOR SIGNATURE/TITLE

 

 

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NAME-Last

First

Middle

Attending Physician

Record No.

Room/Bed

Form 3166P BRIGGS, Des Moines, IA 50306 (800) 247-2343 www.BriggsCorp.com

R304

PRINTED IN U.S.A

Source: Barbara Braden and Nancy Bergstrom. Copyright, 1988.

BRADEN SCALE

Reprinted with permission. Permission should be sought to use this

 

tool at www.bradenscale.com

 

Use the form only for the approved purpose. Any use of the form in publications (other than internal policy manuals and training material) or for profit-making ventures requires additional permission and/or negotiation.

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You have to fill in the NUTRITION Usual food intake pattern, NPO Nothing by mouth IV, FRICTION AND SHEAR, EXCELLENT Eats most of every, COMPLETELY IMMOBILE Does not, VERY POOR Never eats a complete, OR is NPO andor maintained on, VERY LIMITED Makes occasional, receives less than optimum amount, ADEQUATE Eats over half of most, is on a tube feeding or TPN, NO APPARENT PROBLEM Moves in bed, TOTAL SCORE, ASSESS, and DATE space with the required details.

braden scale score chart NUTRITION Usual food intake pattern, NPO Nothing by mouth IV, FRICTION AND SHEAR, EXCELLENT  Eats most of every, COMPLETELY IMMOBILE  Does not, VERY POOR  Never eats a complete, OR is NPO andor maintained on, VERY LIMITED  Makes occasional, receives less than optimum amount, ADEQUATE  Eats over half of most, is on a tube feeding or TPN, NO APPARENT PROBLEM  Moves in bed, TOTAL SCORE, ASSESS, and DATE fields to fill out

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