Below is an excerpt from the Pressure Ulcer Prevention Manual (Revised 2005) as published by Judy Waterlow. Visit www.judy-waterlow.co.uk to purchase your copy.
Download your copy of our simplified Waterlow Guide here. Remember, therapeutic devices should only be used in accordance with manufacturers instructions and under the consent, supervision and management of a suitably qualified health professional.
Assessment is the key to pressure ulcer prevention
The Waterlow pressure risk assessment scoring system has been shown to be, by far, the most frequently used system in UK Acute Care Hospitals (1). It is certainly one that is most easily understood and can be used by staff involved with the admission of patients to hospitals, or nurses/carers working in residential care facilities or in the community.
It must be made clear that like all simplistic scoring systems it can not scientifically predict with 100% precision the chance of a patient developing a pressure ulcer. What it can do is ensure that all patients are assessed as objectively to the same system and thereby placed in a priority order for preventative aids. It also provides evidence to management of the need to purchase equipment. The Waterlow card is another weapon in the armoury of nurses, it is not a replacement for their knowledge and their skills.
If the Waterlow scoring system is adopted as part of a hospital policy and continually monitored, then adjustments can be made for each area of care. This will enable the degree of risk to be modified by an allowance for the preventive measures taken.
As a result of an assessment, patients will be either found to be ‘not a risk’ or will be put into one of three risk categories – at risk; high risk; very high risk.
There is very little point in assessing patients unless the assessor is given guidance in what to do as a result of that assessment.
It is this aspect that makes Waterlow card such a powerful tool. The card gives guidance on the types of preventative aid, which are appropriate to the risk category established earlier. The card quite deliberately avoids listing aids by trade names as it is the responsibility of hospital management to empower the tissue viability nurse to institute a cost effective buying policy, selecting from the many good and effective items of equipment that are to be found on the market.
As is to be expected in a general hospital more patients are to be found ‘not at risk’ or ‘at risk’ than those in ‘very high risk’ category. Statistical evidence of need can be gathered if assessments are documented. This evidence can be very useful in determining stock levels needed for each preventative aid. The longer period of time that records are kept, the more accurate the information.
Ideally the Waterlow scoring system should be used as the assessment and reassessment element of hospital policy. In this way the assessor can be given specific instructions as to what course of action to follow should a patient be deemed to be at risk. This could be the provision of a suitable preventative aid from the available range or could be an instruction to call on the services of a Tissue Viability Nurse to help in deciding what course of action to follow.
1 O’Dea K – Journal of Wound Care, “A review of the use of risk assessment systems in 204 Acute Hospital Trusts”, Vol 8 No 5, May 1999