What is the Waterlow Score?

The Waterlow score is a tool used by hospitals and nursing homes to assess the likelihood that a bed-bound patient may develop pressure sores.

Healthcare professionals should regularly carry out a Waterlow assessment and adjust the patient’s care plan if necessary. Failure to do so might increase the risk of bedsores, adding to the pain and suffering of inpatients.

If you or a family member developed pressure sores while being under professional care and the Waterlow risk assessment was not used, you might have a valid medical negligence claim.

To find out if you have a valid claim, call 0800 470 0474 for a free consultation with a legal adviser. Alternatively, enter your details to request a call back.

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Table of Contents

• What is the Waterlow score?
• How does the Waterlow score work?
• How is the Waterlow score calculated?
• What does the Waterlow score assess?
• Why is Waterlow score important?

What is the Waterlow score?

The Waterlow score was developed in 1985 by Judy Waterlow to assess the risk of bedridden patients for developing bedsores.

Before, there was little consideration towards preventing pressure ulcers. Nurses would instead spend a lot of time trying to cure them. Once bedsores develop, they heal slowly, and some never heal completely.

Nowadays, the Waterlow scale is the most frequently used prevention tool in the UK to evaluate the risk of pressure sores.

The assessment is easy to understand and utilised by carers and healthcare professionals. The Waterlow has applicability in all areas of care.

The Waterlow risk assessment should be followed by preventive aids and interventions, depending on the needs of each patient.

If you were under professional care and was not assigned a Waterlow score, this could be considered medical negligence. If you have developed pressure ulcers, you might be entitled to claim compensation.

To find more about how the Waterlow score relates to your injury claim, you can call 0800 470 0474 for a free consultation with a legal adviser.

How does the Waterlow score work?

The Waterlow score gives an estimated risk for developing bedsores in a given patient. The assessment involves compiling a Waterlow Score Card by assigning a point value to several categories.

Every Score Card contains seven categories to consider, including build, continence, mobility, skin type and special needs. All these factors are associated with an increased risk for developing bedsores.

For an accurate score, healthcare professionals should use their best clinical judgement, together with factual information about the patient’s health.

Each group has multiple choices, with a set value of points assigned to each answer. After filling in the Score Card, the numbers get summed up to give the risk score.

Potential scores range from 1 to 64, where the maximum score corresponds to an almost 100% certainty the patient will develop sores. Likewise, a score of 1 means there is no risk of damage to the skin.

A user manual is also available, which gives detailed information about each of the parameters used in the assessment, and how to effectively use the scale. It also contains details about cost-effective approaches to prevent bedsores.

How is the Waterlow score calculated?

The scoring system of the Waterlow scale is a simplistic tool. The assessors must interpret the Waterlow score with professional expertise and take the necessary steps to prevent patients from developing bedsores.

The scale evaluates seven patient characteristics, each assigned a point value based on severity. The points get summed up to give an overall score, representing the patient’s risk of developing pressure sores.

The primary factors associated with the risk of developing bedsores are:

• Build / Weight for Height, which takes into account the patient’s Body Mass Index (BMI), scored from 0-3.
• Skin Type / Visual Risk Areas scored from 0-3. Dry, oedematous or clammy skin gets damaged more easily. Discolouration or spots are warnings of pressure damage already occurring.
• Sex / Age. There is a higher incidence of bedsores in women, possibly related to the shape of the pelvis. A male would be assigned 1 point, while a female 2. The risk of skin damage also increases with age due to losing elasticity and plumpness. Age groups get scored from 1-5.
• Continence. Incontinence brings excess moisture to the skin, causing softening and erosion of the epidermis. Scores range from 0 to 3 (double incontinence).
• Mobility evaluates the ability to move and the level of restlessness. The patient score can range from fully mobile with no restrictions (0 points) to permanently chair bound (5 points).
• The Malnutrition Score takes into account recent weight loss and the severity of weight reduction, scored from 0-4. Poor nutrition affects skin elasticity and subcutaneous tissue, making it more prone to damage.
• Special Risks. Point values are assigned based on specific or temporary conditions. A smoker will receive an additional point, while patients with multiple organ failure would get 8 points.

After filling in the Score Card, the points get added up. The final value represents the Waterlow score. It is an essential tool for assessing the patient’s risk for developing pressure sores. There are three bedsore risk categories:

• Low to medium risk: a score of 10-14
  High risk: a score of 15-19
  Very high risk: 20+ points
• Healthcare professionals should take appropriate measures according to each risk category. When failing to do so, they might be liable for medical negligence.

If you or a loved one didn’t receive the appropriate assistance based on your Waterlow score, you could make a medical negligence claim. For more information, call the free number 0800 470 0474 to consult with a legal adviser. Alternatively, please fill out our online claim form and request a call back.

What does the Waterlow score assess?

Pressure sores can develop remarkably quickly. Aside from being painful, they can give rise to severe complications, some of which are life-threatening. These include:

• cellulitis, an inflammation that causes swelling and redness
• sepsis, if bacteria enter the bloodstream, which might lead to limb amputations in severe cases
• bone and joint infections, which can impair joint and limb function
• abscess, if the wound gets infected
• cancer, if the sores don’t get proper treatment for long periods

The most affected body parts are the buttocks and the heels, but sores can also develop on the head, shoulders, knees, ankles and toes.

The Waterlow scale became an indispensable tool in assessing the risk for developing bedsores in bedridden patients. The score is especially relevant for patients at high risk, with prolonged hospitalisation and restricted mobility or in a state of unconsciousness. Failure to assess the Waterlow score would generally be considered medical negligence if it leads to avoidable injury.

Aside from the primary use in assessing the risk for developing ulcers, the Waterlow can be a meaningful tool for risk assessment in surgical patients. A preoperative Waterlow assessment has the potential value to predict mortality and morbidity in surgical patients.

Why is Waterlow score important?

The Waterlow score is a relevant tool intended for routine assessments to prevent bedsores. Healthcare professionals should use the Waterlow assessment as a means to establish the risk status of the patient.

Bedridden patients, as well as residents of nursing homes, are at risk for developing pressure sores. If the skin is in constant contact with a bed or chair, the pressure and friction can lessen the blood flow and make the skin more vulnerable to injury. These can lead to pressure sores with different levels of severity:

• grade I – skin discolouration
• grade II – skin loss or damage involving the top layers
• grade III – necrosis or injury limited to the skin layers
• grade IV – necrosis or damage to the skin and underlying structures, such as tendon, joint or bone.

Healthcare professionals must develop a care plan, depending on the patient’s risk for developing pressure sores. Preventive measures include:

• regular repositioning, as often as once every hour for patients at high risk
• the use of cushions and mattresses that relieve pressure
• adjusting the bed elevation to prevent shearing
• use appropriate wound dressings
• the use of good quality, speciality wheelchairs
• eating good, nutritious meals
• keeping the skin clean and dry and using moisture barrier creams
• daily inspection of the skin

The Waterlow risk assessment does not imply that bedsores are inevitable. Nurses and carers must nonetheless take all feasible precautions to avoid sores from happening. When failing to do so, they might be liable for medical negligence.

For more information on how you can make a medical negligence claim involving the Waterlow score, call free on 0800 470 0474 for a conversation with a legal adviser. Otherwise, you can fill in our online form and receive a call back shortly.