Introduction to the Waterlow Scale & pressure ulcers

The majority of information that is required to calculate a Waterlow Score is easily obtainable. This means using the Waterlow tool regularly is a great way to closely monitor a variety of health categories that otherwise might not have been areas of concern.

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Contents

Welcome

Pressure ulcers can form for a number of reasons and anybody can get them. In a care environment, they can appear quickly and may take anywhere from days to months to heal, depending on the severity. Not only are they painful but they can cause infections, itching, odours and open wounds, which slow down progress being made towards other personal or healthcare goals.

Catching them early and preventing them all together will give your residents the best chance of success and allow them to continue leading a normal life. A risk assessment tool like the Waterlow Scale can support you with this. In this ebook, we explore the causes of pressure ulcers, preventative measures, how the Waterlow tool works and how technology can further assist you with managing sores in a care setting.

CareDocs Waterlow Scale Ebook 1

What are pressure ulcers?

Pressure ulcers, also known as pressure sores or bedsores, can occur when there’s prolonged pressure on the skin, causing injury to the skin and underlying tissue. Symptoms can range from discoloured skin, itchiness, or pain, to more severe lesions like an open or deep wound which can become life-threatening if left untreated.

People who have limited mobility, are confined to bed, are obese, have a poor diet, or have certain medical conditions that affect the blood supply are most likely to develop them. Due to a combination of lifestyle factors, this means elderly people are naturally at greater risk, and even more so if they have a degenerative condition such as Alzheimer’s.

The level of treatment varies depending on how serious the ulcers have become. The most common methods of care include relieving pressure by applying dressings, eating a healthy diet, regular rotation in bed, increasing mobility or using preventative aids that promote better blood flow. Debridement or surgery are also necessary in severe cases.

Pressure-relieving aids

The best action against ulcers is to prevent them from developing. Performing a regular risk assessment is an effective tool for identifying why, where and when a sore may form. Although you can often do things to address the root of the issue – like encouraging mobility and a healthier diet – many individuals will require extra support. For residents who cannot move easily or at all, regular repositioning is vital. But for cases where an ulcer is likely to develop or has developed, preventative or pressure-relieving aids are another layer of protection that can help.

Preventative aids consist of specialist equipment, such as padded, foam and air mattresses, overlays and cushions. You can also relieve pressure by ensuring the individual has the right bed, duvet, chair or clothing for their particular condition. Barrier creams are also recommended to help protect skin from becoming damaged and to minimise irritation.

Skin massage or rubbing should NOT be offered to individuals of any age to attempt to prevent pressure ulcers from forming. This is contrary to what many people might think, as it’s commonly understood that stimulating skin increases blood flow to the area. However, there’s no evidence to support that it is beneficial in this scenario and it can potentially lead to tissue damage.

Pressure ulcer risk assessments

Because everybody has different needs, the best way to identify pressure ulcer risk is to carry out thorough risk assessments for each resident. This is a person-centred approach to caring which will return the greatest benefits to all parties. It ensures the most effective and beneficial service is being provided, so time and resources are not wasted.

There are several well-known assessments that are used to estimate the risk of developing pressure injuries. These include the Waterlow Scale (or Waterlow Score), Braden Scale, Norton Scale, Douglas Scale and Cubbin-Jackson Scale. The Waterlow tool is reportedly the most frequently used system of its kind in the UK.

Waterlow Scale / Score Chart - CareDocs

What is the Waterlow Scale & how can it help assess the risk of pressure injuries?

The Waterlow tool is a risk assessment that was researched and designed by Judy Waterlow MBE in 1988 and updated in 2005. It calculates the estimated risk of pressure ulcers developing in adults through a simple points-based system using individual data. Its effectiveness has been proven in a variety of settings and is commonly used in community hospital, residential care and nursing home settings.

To get started, you must first download the Waterlow Score Card for reference, which is provided free of charge on the official website. One side of the card displays the risk scoring system, while the reverse side provides prevention, nursing care and wound guidance. You can also purchase a user manual directly from the Waterlow website which covers the subject of pressure ulcers in more detail.

The front side of the Score Card contains several categories relating to readily accessible resident information. This includes the build / weight of the resident, their height, skin condition, sex / age, continence, mobility and special risk factors like tissue malnutrition, medication, major surgeries, trauma and neurological deficit. You must then use a combination of factual readings about a resident’s health along with your best clinical judgement to match your answers to the most suitable choices on the Score Card.

Each choice has a set value of points, which when tallied up at the end of the assessment will give you the total risk score. If the resident scored between 10-14 then they are considered at risk, 15-19 is high risk and if they reach 20+ the risk is classed as very high. If a resident is at risk, you can use this to form an appropriate care plan and utilise the prevention and nursing care guidance on the back of the Score Card to manage ulcer development.

What are the benefits of using the Waterlow tool?

The Waterlow tool has been researched thoroughly and has been used internationally for decades. It’s trusted in a range of care settings like community hospitals, residential care homes and nursing homes as a reliable and simplistic method of estimating the risk of pressure ulcer development. By using a risk assessment to identify potential ulcers before they form, it becomes easier to stop them from occurring or to manage the recovery process. The most effective action against pressure ulcers is prevention.

Another valuable aspect of the Waterlow tool is that it provides guidance on preventative measures depending on the risk score. This enables care workers of all experience levels to act quickly and with confidence in a range of scenarios. However, because the risk is estimated, best judgement should always be applied when responding.

The majority of information that is required to calculate a Waterlow Score is easily obtainable. This means using the Waterlow tool regularly is a great way to closely monitor a variety of health categories that otherwise might not have been areas of concern. While looking for pressure ulcer risk, you can also use the data to identify any other previously unknown health conditions related to BMI, skin type, malnutrition, continence, mobility and additional special risks.

How can technology help manage pressure ulcers?

CareDocs Waterlow Scale Ebook 3

The Department of Health and Social Care has set a goal to help increase the number of social care providers that use digital care records in England to 80% by 2024. In terms of record-keeping and making information more easily accessible, the sector is moving quickly towards becoming completely digital. But it’s important to highlight that technology can provide many other benefits to support your care service.

Alongside digital record-keeping, there are several easy to use digital tools that can help care providers manage the prevention and occurrence of pressure ulcers. These tools, and many more, can be accessed by implementing a care management system like CareDocs in your care setting.

Care planning

Judy Waterlow has kindly permitted for CareDocs to use the Waterlow system as part of our care assessment and care planning process. The Waterlow tool features specifically within the Skin Integrity assessment, where you can enter the same information as required on the Score Card. The software will tally the values automatically. In addition to Waterlow, we also include other questions focusing on the SSKIN model for preventing sores including pressure relieving aids.

The final Waterlow risk score and any contributing factors are then delivered to you in the resident’s personalised care plan. If there is a risk of developing sores or moisture lesions, the appropriate action to prevent this from happening will be included in the plan. CareDocs details each resident’s abilities and needs, and the intervention and support that should be provided to help them prevent developing pressure injuries. Any specific treatment required for current conditions is also outlined.

Forms & reports

Among the various forms at your disposal, our SSKIN inspection form gives you the option to log detailed information about multiple areas of health for a resident. You can include everything related to pressure wounds, like risk assessment scores, surface aid use, skin texture, repositioning routine, incontinence and nutrition notes. CareDocs will generate an instant report for multiple residents using completed forms to give you a quick overview of who may be at risk of developing a pressure ulcer.

For dedicated care tasks – like rotation – a digital repositioning form gives you the option to record the date and time of each repositioning. You can also enter the new position, whether specialist equipment was used and any additional supporting notes. For residents who are at risk of malnourishment, there are a series of nutrition and hydration related forms to help you monitor their intake.

Forms can be accessed on our point of care recording application, so you can remotely check when the next repositioning, food or drink is due.

Charts & records

If a pressure ulcer has formed, easily create digital Body Maps to record where they are located and the plan of action you are taking to treat them. As the treatment progresses, record new notes against the existing body map chart or store photographs to document the healing progress. For example, to evidence the use of topical medications or barrier creams. Once the condition has healed you can archive the relevant body map chart and view it again later if needed. Body maps are also available to view on our mobile application.

With the Daily Notes feature, you can quickly record and locate written notes about events related to treatment and activities, such as debridement or dietician visits. Where applicable, you can support each note with an Emotion Mapping record to further demonstrate the resident’s mood or feelings at the time.

Policies & procedures

Our care experts have created a huge variety of template policy documents, including a policy for maintaining skin integrity. You can import the digital document into your system and personalise it to reflect the needs of your home. In CareDocs, you have the option to create new documents or paste your existing policy and procedures into the system to keep everything in one place. There are also built-in monitoring features to help you keep track of who has read them.

For more information about how CareDocs can make a difference for your care home, get in touch today to learn more. Call us on 0330 056 3333 or email sales@caredocs.co.uk.

Sources

Download your free ebook!

Don’t forget to grab your copy of our free Introduction to the Waterlow Scale and Pressure Ulcers ebook…

Originally published on April 28, 2022
Article updated on June 1, 2023

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