Learn how home health nurses use the Braden Scale to assess skin breakdown risk during the Start of Care (SOC) visit. Discover scoring, interventions, and compliance tips.
Introduction: Why Skin Risk Assessment Is Essential
In home health, skin assessments save lives. Pressure injuries (bedsores) don’t just cause pain—they increase infection risk, prolong recovery, and drive up hospital readmissions. That’s why Medicare requires a risk screen during the Start of Care (SOC) visit.
One of the most widely used and evidence-based tools is the Braden Scale. It’s a must-know for every RN in home health.
What Is the Braden Scale?
The Braden Scale predicts the risk of developing pressure injuries by scoring patients across six categories:
- Sensory Perception – Ability to respond to discomfort/pain.
- Moisture – Degree to which skin is exposed to moisture.
- Activity – Degree of physical activity.
- Mobility – Ability to change and control body position.
- Nutrition – Usual food intake pattern.
- Friction & Shear – Risk related to movement in bed/chair.
Each area is scored 1–4 (except Friction & Shear, scored 1–3). The total score ranges from 6–23:
- 19–23 = No risk
- 15–18 = Mild risk
- 13–14 = Moderate risk
- 10–12 = High risk
- ≤9 = Very high risk
Why the Braden Scale Works in Home Health
- Holistic: Goes beyond skin inspection by considering nutrition, mobility, and moisture.
- Evidence-based: Backed by decades of research.
- Action-oriented: Guides nursing interventions and caregiver teaching.
- Compliance tool: Helps justify skilled nursing visits for skin care and prevention.
👉 Want more on risk screening? See my post on Risk Screens: Falls, Depression, Nutrition, Pain & Skin.
Applying the Braden Scale at SOC
- Pre-Chart: Check hospital or rehab notes for prior wounds (see Pre-Charting & Call-Ahead).
- Assess Each Category: Observe skin, ask about nutrition, note mobility and moisture factors.
- Score & Document: Record accurately and explain clinical reasoning.
- Intervene: Educate caregivers on repositioning, moisture management, and nutrition support.
- Care Plan: Align your interventions with risk areas identified.
Common Mistakes to Avoid
- Scoring too high: Overestimating patient activity or nutrition skews results.
- Not tying score to plan of care: Medicare expects interventions that match the risk.
- Ignoring caregiver input: Families often notice skin changes before nurses do.
👉 For guidance on linking assessments to compliance, check out my post on Comprehensive Assessment & Functional Testing.
Final Thoughts: Prevention Is Power
The Braden Scale isn’t just a form to fill out—it’s a preventive tool that helps patients stay safe at home. By taking it seriously, RNs can reduce pressure injury risk, protect patients, and prove the skilled need that keeps home health services covered.
✨ Want step-by-step guidance on SOC visits, including skin risk assessments like the Braden Scale?
Check out my RN Home Health SOC Guidebook on Kindle. It’s packed with real-world examples, compliance strategies, and checklists to make every SOC visit smoother and more effective.
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