Braden Scale Pressure Ulcer Risk Assessment Form
Complete this Braden Scale Pressure Ulcer Risk Assessment Form to evaluate pressure ulcer risk using standardized criteria. Please provide all requested information for accurate assessment.
Patient Full Name
*
First Name
Last Name
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor Name
*
First Name
Last Name
Location/Unit
*
Sensory Perception: Ability to respond meaningfully to pressure-related discomfort
*
Completely limited
Very limited
Slightly limited
No impairment
Moisture: Degree to which skin is exposed to moisture
*
Constantly moist
Very moist
Occasionally moist
Rarely moist
Activity: Degree of physical activity
*
Bedfast
Chairfast
Walks occasionally
Walks frequently
Mobility: Ability to change and control body position
*
Completely immobile
Very limited
Slightly limited
No limitations
Nutrition: Usual food intake pattern
*
Very poor
Probably inadequate
Adequate
Excellent
Friction and Shear: Degree of assistance needed to move and likelihood of sliding
*
Problem
Potential problem
No apparent problem
Submit Assessment
Should be Empty: