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.
AverageAbove averageObeseBelow
AveragePoorNG tube/ fluids onlyNBM/ anorexic
Completely catheterizedOccasionally incontinentCatheterized / incontinent of fecesDouble incontinent
Terminal cachexiaCardiac failurePeripheral vascular diseaseAnaemiaSmoking
HealthyTissue paperDryOedematousClammy (Temp increase)DiscolouredBroken/spot
Diabetes, MS, CVAMotor/SensoryParaplegia
Fully MobileRestless/FidgetyApatheticRestrictedInert/TractionChairbound
Orthopaedic - below waist, spinalOn table for over 2 hours
MaleFemale
14-4950-6465-7475-8080+
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

Clear
Should be Empty: