---
name: waterlow-pressure-ulcer-risk-assessment
description: Use when asked to administer, score, or explain the Waterlow Pressure Ulcer Risk Assessment — a summed weighted-category score where higher total means higher risk — grounded in FormExamples/form-examples; the inverse-scaled counterpart to integumentary-assessment's Braden Scale.
---

# 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](https://github.com/FormExamples/form-examples/tree/main/forms/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.