Waterlow Form

Waterlow Form
Waterlow Pressure Risk Assessment Scale:

Adapted from Cook M, Hale C and Watson B. Interrater reliability and the assessment of pressure- sore risk using an adapted Waterlow Scale, Clinical Effectiveness in Nursing.
Patients Name*
Today's Date*

DayMonthYear
Date
Several scores per category can be used.
Build/Weight for height:*

AverageAbove averageObeseBelow
Appetite:*

AveragePoorNG tube/ fluids onlyNBM/ anorexic
Continence:

Completely catheterizedOccasionally incontinentCatheterized / incontinent of fecesDouble incontinent
Tissue Malnutrition:

Terminal cachexiaCardiac failurePeripheral vascular diseaseAnaemiaSmoking
Skin type: visual risk area:*

HealthyTissue paperDryOedematousClammy (Temp increase)DiscolouredBroken/spot
Neurological deficit:

Diabetes, MS, CVAMotor/SensoryParaplegia
Mobility:*

Fully MobileRestless/FidgetyApatheticRestrictedInert/TractionChairbound
Major surgery/trauma

Orthopaedic - below waist, spinalOn table for over 2 hours
Gender*

MaleFemale
Age*

14-4950-6465-7475-8080+
Medication:

Cytotoxic, high doses of steroids, anti-inflammatory
Total Score (calculated)
Sum:

0-9 - No Risk

10-14 - At Risk

15 - 20 - High Risk

20+ - Very High Risk
Risk Level (calculated)
Your Full Name

First NameLast Name
Your Signature
Should be Empty: