Waterlow Pressure Ulcer Risk Assessment

A bedside screening tool that estimates an adult patient's risk of developing a pressure ulcer (pressure sore, bedsore, decubitus ulcer). It records a set of weighted risk categories — build/weight for height (BMI), skin type and visual risk areas, sex and age, continence, and mobility — plus four groups of special risk factors (tissue malnutrition, neurological deficit, major surgery or trauma, and medication), sums the points into a single total, and places the patient in a risk band. A higher total means higher risk: the band drives escalation of pressure-relieving support surfaces, repositioning frequency, and skin-care review.

Devised by Judy Waterlow (1985, revised 2005), the Waterlow score is the most widely used pressure-ulcer risk tool in United Kingdom nursing.

Scoring: higher total = higher risk

Each core category (build/BMI, skin type, sex and age, continence, mobility) contributes the points of its single selected option; each special-risk group (tissue malnutrition, neurological deficit, major surgery/trauma, medication) contributes the points of the highest applicable option within that group. The total sum places the patient in a risk band, driving prevention measures.

What it covers

Assessment context; patient identification; build/weight for height; skin type/visual risk; continence; mobility; tissue malnutrition; neurological deficit; major surgery or trauma; medication; and a summary with the computed total, risk band, contributing categories, and prevention recommendation.

Relationship to the Braden Scale (integumentary-assessment)

Critical distinction: Waterlow is a higher-is-worse summed score; the Braden Scale used in Integumentary Assessment is an inverse scale where a lower total means worse risk. Never compare raw numbers between the two instruments — always convert to the named risk band first.

Common pitfalls

• Confusing Waterlow's direction with Braden's — this is the single most consequential mistake when working across pressure-ulcer risk tools; see the distinction above.
• Missing a special-risk-factor group because no core category captures it — tissue malnutrition, neurological deficit, major surgery/trauma, and medication are scored in addition to the core categories specifically because they're independent risk contributors not otherwise captured.
• Scoring once at admission and not repeating — pressure-ulcer risk changes with mobility, nutrition, and clinical status; reassess on a schedule and after any significant change in condition.

Learn more

• FormExamples: waterlow-pressure-ulcer-risk-assessment for the full implementation, clinical references, and worked examples.
• Integumentary Assessment for the related Braden Scale (inverse-direction) pressure-ulcer risk tool.