Nursing care
Braden scale: how to score the six subscales and what each risk range asks of the nurse
Written and reviewed by Rachel Goldberg, MSN, RN, CEN · 5 min read · Updated November 2026
Short answer
The Braden scale rates pressure injury risk across six subscales, and the total runs from 6 to 23. Lower means higher risk. AHRQ treats 18 or less as at risk, and common bands are 15 to 18 low, 13 to 14 moderate, 10 to 12 high and 9 or less very high. Score on admission, then daily or after any significant change.
The six subscales and what a low score means
Five subscales are scored from 1 to 4 and the sixth, friction and shear, from 1 to 3. A score of 1 always means the worst function in that area. The descriptions below are a plain-language summary, not the wording of the instrument, which is published by its authors.
| Subscale | What it measures | Lowest score suggests | Highest score suggests |
|---|---|---|---|
| Sensory perception | Ability to feel and report pressure discomfort | No meaningful response to pain | Feels and reports discomfort normally |
| Moisture | How often skin is damp from sweat, urine or stool | Skin wet almost all the time | Skin usually dry |
| Activity | How much the person walks or gets out of bed | Confined to bed | Walks often, in and out of the room |
| Mobility | Ability to change and control body position | Makes no position changes alone | Changes position freely and often |
| Nutrition | Usual food and protein intake | Eats very little, or nothing by mouth for days | Eats most of every meal |
| Friction and shear | Sliding and dragging during moves | Needs full help and slides down in bed | Moves without sliding (maximum 3) |
Add the six numbers for a total between 6 and 23. AHRQ notes that the 18 cut point may need adjusting for a particular unit or patient population, so learn your facility's threshold as well as the textbook one.
Risk bands and the nursing response at each level
The bands below are the ones used in recent validation research. Actions are drawn from the AHRQ sample care plan, which ties interventions to each subscale rather than to the total alone. More risk means more intensive prevention, not a different kind of care.
| Total score | Risk band | Typical nursing focus |
|---|---|---|
| 19 to 23 | No identified risk | Routine skin checks; reassess if condition changes |
| 15 to 18 | Low (at risk) | Skin inspection each shift, heel checks, encourage mobility, manage moisture |
| 13 to 14 | Moderate | Add a posted turning schedule and pillows between bony prominences |
| 10 to 12 | High | Reposition every 1 to 2 hours, elevate heels, consider a specialty surface |
| 9 or less | Very high | All of the above plus specialty bed and team input on nutrition and mobility |
AHRQ is explicit that an abnormal score on any single subscale should be addressed even when the total looks acceptable. A patient scoring 1 on moisture needs barrier products and frequent pad checks whatever the total says.
Worked example: scoring a hypothetical patient
Hypothetical practice patient: an 81-year-old on day two after hip fracture repair. She answers questions but cannot always say when she is uncomfortable, has occasional urinary incontinence, is on bed rest, shifts slightly without help, eats about half her meals and slides down in bed between boosts.
Worked example
- Sensory perception: responds to voice but cannot always report discomfort = 3
- Moisture: occasionally moist = 3
- Activity: bedfast = 1
- Mobility: small shifts only, very limited = 2
- Nutrition: eats about half of meals, probably inadequate = 2
- Friction and shear: slides down and needs lifting = 1
- Add: 3 + 3 + 1 + 2 + 2 + 1 = 12
Notice that two subscales scored 1. Those, not the total, tell you what to do first: use a lift sheet so she is not dragged, keep the head of the bed low when safe, and float her heels off the mattress.
Where the Braden scale misleads
In intensive care the scale tends to flag almost everyone. A Korean ICU study of more than 2,000 patients found a cutoff of 14 gave sensitivity of 0.89 but specificity of only 0.51, and a 2026 comparison of five tools in ICU patients found none, Braden included, reached acceptable accuracy. A high-risk label in the ICU is expected, so act on the specific subscales and devices.
AHRQ also warns that general scales differentiate risk poorly in children, people with spinal cord injury, palliative care patients and patients in the operating room, where specialized tools exist. The pediatric Braden Q is one example. Medical devices are another blind spot: the scale does not ask about tubing or masks, so inspect skin under oxygen tubing, catheters and compression stockings separately.
Exam trap: a fine total with one dangerous subscale
Hypothetical question, not a real exam item: four clients are listed with their Braden totals of 20, 17, 16 and 19. Which needs a pressure injury prevention plan today? Students often choose only the lowest total. Both the 17 and the 16 are at risk (18 or below), and a 19 with a moisture score of 1 also needs a targeted plan.
The second error is treating the score as a substitute for looking at skin. AHRQ frames risk tools as one input alongside a full skin assessment and clinical judgment, so an answer that inspects the sacrum and heels beats one that only recalculates the score.
Sources and further reading
AHRQ Preventing Pressure Ulcers in Hospitals: 3. Best practices in pressure ulcer prevention. Six subscales, totals 6 to 23, 18 or less at risk and threshold adjustment, admission then daily or change-in-condition reassessment, skin under devices, weaker differentiation in pediatrics, spinal cord injury, palliative and OR patients.
AHRQ Tool 3D: Braden Scale and sample care plan. Subscale scoring 1 to 4 and 1 to 3, address abnormal subscale scores, interventions such as heel elevation, posted turning schedule, repositioning every 1 to 2 hours, specialty surfaces, moisture care.
Comparison of the Validity and Reliability of Five Pressure Injury Risk Scales in Intensive Care (Nursing in Critical Care, 2026). Braden risk bands (9 or less, 10 to 12, 13 to 14, 15 to 18, 19 to 23) and no ICU tool reaching acceptable predictive accuracy.
Effects of Extended ICU Length of Stay on Braden Scale Validity (Journal of Nursing Research, 2026). Cutoff of 14 with sensitivity 0.89 and specificity 0.51 in ICU patients; reduced Braden accuracy in ICU settings.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our reduction of risk potential practice questions are the closest set to what this page covers.
One question from the reduction of risk potential set
Four hours after a cardiac catheterization via the right femoral artery, the nurse notes the client's right dorsalis pedis pulse is now faint and the foot is cool and pale. What is the nurse's priority action?
Rationale
A pulse that was present and is now faint, with a cool, pale extremity distal to the puncture site, is arterial occlusion until proven otherwise — a limb-threatening complication that needs the provider now. Documenting and rechecking wastes the window, warming treats the symptom and masks the change, and asking the client to move the ankle neither restores flow nor gives you new information.
Answer: C
Common questions
What is a high-risk Braden score?
In the common banding, 10 to 12 is high risk and 9 or less is very high risk. Any total of 18 or less is considered at risk by AHRQ, though facilities may adjust that threshold for their own patients.
What are the 6 categories of the Braden scale?
Sensory perception, moisture, activity, mobility, nutrition, and friction and shear. The first five are scored 1 to 4 and friction and shear is scored 1 to 3, giving totals from 6 to 23.
How often is a Braden assessment done?
AHRQ suggests scoring on admission in general acute care, then daily or whenever the patient's condition changes significantly. Units where status changes quickly, such as critical care, often reassess more frequently under local policy.
More on reduction of risk potential