1. Braden Scale Mobility Subsection
For subsection scores 1 or 2 always apply the high risk interventions!
Mobility 4
NO LIMITATION 3
SLIGHTLY LIMITED 2
VERY LIMITED 1
COMPLETELY IMMOBILE
Identify The Patients Ability To Change And Control Body Positions!
Makes major and frequent changes in position
Does not need assistance to change position in bed or while in chair
Makes frequent though slight changes in position
Minimal or no assistance needed with positioning
Makes occasional or slight body and/or extremity position
Needs assistance with repositioning minimum x1 assist
Does not make even slight changes in body or extremity position
Total care- minimum x2 assist
High Risk Interventions
High Risk Low Risk
Assist to chair position for all meals; at least twice daily
Apply appropriate pressure relief surfaces
Turn every 2 hours with 30 degree tilt
Do not use donuts or rings
Shift weight every 15 minutes while up in chair