Pressure ulcers (also called pressure sores or bedsores) are areas of damage to the skin and underlying tissue caused by prolonged pressure. They are a significant cause of morbidity in care homes and can lead to pain, infection, extended hospital stays, and in severe cases, death.
The Waterlow Score, developed by Judy Waterlow in 1985, is the most commonly used pressure ulcer risk assessment tool in UK healthcare. It helps identify residents at risk so preventive measures can be implemented early.
Assessment Categories
The Waterlow assessment considers multiple risk factors, each contributing points to an overall score:
Build/Weight for Height (BMI)
- Average: 0 points
- Above average: 1 point
- Obese: 2 points
- Below average: 3 points
Skin Type/Visual Areas at Risk
- Healthy: 0 points
- Tissue paper: 1 point
- Dry: 1 point
- Oedematous: 1 point
- Clammy/pyrexia: 1 point
- Discoloured: 2 points
- Broken/spot: 3 points
Sex/Age
- Male: 1 point
- Female: 2 points
- 14-49: 1 point
- 50-64: 2 points
- 65-74: 3 points
- 75-80: 4 points
- 81+: 5 points
Continence
- Complete/catheterised: 0 points
- Occasionally incontinent: 1 point
- Catheter/incontinent of faeces: 2 points
- Doubly incontinent: 3 points
Mobility
- Fully: 0 points
- Restless/fidgety: 1 point
- Apathetic: 2 points
- Restricted: 3 points
- Inert/traction: 4 points
- Chairbound: 5 points
Appetite/Nutrition
- Average: 0 points
- Poor: 1 point
- NG tube/fluids only: 2 points
- NBM/anorexic: 3 points
Special Risks
Additional points for tissue malnutrition (8 points), neurological deficit (up to 6 points), major surgery/trauma (up to 8 points), and medication (up to 4 points for steroids, cytotoxics, anti-inflammatories).
Interpreting the Score
10-14: At Risk
Implement basic prevention measures. Consider pressure- relieving mattress. Regular position changes.
15-19: High Risk
Pressure-relieving mattress essential. 2-4 hourly repositioning. Close monitoring of pressure areas. Consider specialist equipment.
20+: Very High Risk
Alternating pressure mattress required. Intensive repositioning schedule. Skin inspection at every position change. Nutritional support. Consider Tissue Viability Nurse referral.
When to Review
The Waterlow assessment should be reviewed:
Minimum Routine Reviews
- On admission: Complete full assessment within 6 hours
- Weekly: For very high risk residents (20+)
- Monthly: For high risk residents (15-19)
- Monthly to quarterly: For at risk residents (10-14), depending on stability
Trigger Events for Immediate Review
Best Practice Tips
Common Errors to Avoid
- Copy-paste assessments: Each review should reflect current status, not reproduce previous entries
- Forgetting special risks: Medication changes and neurological conditions are often missed
- Not acting on score: Assessment without corresponding intervention is pointless
- Over-reliance on score alone: Clinical judgement should supplement the tool—someone may be high risk despite a moderate score
- Inconsistent reviewers: Different staff may score differently—standardise training
Key Takeaway
The Waterlow assessment is a valuable tool, but only when used correctly and consistently. Assess on admission, review at appropriate intervals based on risk level, reassess immediately when conditions change, and always link the score to specific prevention interventions in the care plan.
Automated Waterlow Scoring
Revitaco calculates Waterlow scores automatically and alerts when reviews are due or risk levels change.
Book a Demo