What is the Waterlow Score and how can it help assess risk of pressure injuries?

The Waterlow assessment was designed and researched by Judy Waterlow. It calculates the risk of pressure ulcers developing on an individual basis through a simple points-based system.

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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 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 in general are naturally at greater risk, and even more so if they have an illness like dementia.

The level of treatment varies depending on how serious the sores have become. The most common methods include relieving pressure by applying dressings, eating a healthy diet, regularly changing position in bed, increasing mobility or using specialist mattresses or cushions that promote better blood flow. Debridement or surgery are also used in more severe cases. However, the best way to avoid any treatment is to prevent the sores from developing in the first place

Risk assessments

Because everybody has different needs, the best way to prevent pressure sores 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 Waterlow, Braden Scale, Norton Scoring system, Douglas Scale and Cubbin-Jackson. The Waterlow pressure ulcer risk assessment and prevention tool was designed in 1988 for community hospital, nursing and residential care home use. It’s easy to use and is reportedly the most frequently used system of its kind in the UK.

How does Waterlow work?

The Waterlow assessment was designed and researched by Judy Waterlow. It calculates the risk of pressure ulcers developing on an individual basis through a simple points-based system. To get started, you must first download the Waterlow Score Card for reference, which is provided free of charge on the official website. You can also purchase a user manual which explains how the assessment works and covers the subject of pressure ulcers in more detail. 

The Score Card contains several categories for you to consider 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 information about your 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 risk score. If the resident scored between 10 – 14 they are considered at risk, 15 – 19 is high risk and if they exceeded 20+ the risk is classed as very high.

Waterlow in CareDocs

Judy Waterlow has kindly given permission for CareDocs to use the Waterlow system as part of our Care Assessment process. It features specifically in the Skin Integrity assessment, where you can ask and enter the same information as required on the Score Card and we tally the values automatically. We also include other questions focusing on the SSKIN approach to preventing pressure ulcers. 

To give you and your residents some extra help in deciding the most accurate option in each Waterlow category, we have written a quick description of the different options where applicable. For example, when choosing which option best represents their skin condition, you can talk your resident through what each option means, such as ‘oedematous’, in simpler terms. 

The final 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 should be taken to prevent this from happening. CareDocs details the 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. 

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 on SalesGroup@caredocs.co.uk.  


Originally published on November 24, 2020
Article updated on July 7, 2021

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