Waterlow Score : Frequently Asked Questions

Here are some of the questions most frequently asked.


Q Why do females score ‘2’ and males ‘1’

A ‘Sex’ was included on the card to take account of the research findings of Dr M Versluysen in 1986 – How elderly patients with femoral fractures develop pressure ulcers in hospital BMJ 292 May 17 pp1311-1313. Subsequent research by Bale S, Finlay I, Harding K 1995: Pressure ulcer prevention in a hospice; Journal of Wound Care Nov. Vol.4 No.10 pp465-468 also showed the male/female difference. My own personal view is that the ‘extra risk’ is due to anatomical differences. It is much more difficult to keep women clean, dry, and free from the effects of urinary incontinence. In the case of men external catheters can keep the groin area dry.

Q Why does the revised Waterlow scoring system use the Australian malnutrition screening tool MST, rather than the UK malnutrition universal screening tool MUST.

A MST was chosen by the Australian team which conducted the 5 year research project which looked into, amongst other things, whether there was a need to update Waterlow as a consequence of the passing of the years since I designed the original scoring system. As I participated in the project and was happy with their findings I revised Waterlow in the light of those findings. A fuller explanation and the reason that using MST in Waterlow and MUST to identify a risk of poor protein-energy status (for which it was designed) should cause no practical problems can be found by downloading the following file. Click Here to download.

Q Why assess patients/clients ?

A To identify those at risk of developing pressure ulcers (bedsores) and enable a cost effective plan of care to be prepared by a trained nurse. This care plan should identify risk factors, risk status, proposed action and date for reassessment.

Q Why is it necessary to document this information?

A To provide consistency of care and objective evidence for audit.
Full and complete documentation protects staff working in the Hospital, Community or Care Homes in cases of Litigation.

Q Who should be assessed?

A All patients/clients who enter hospital, nursing or residential homes or who are cared for in the community.

Q Why weigh and measure the clients?

A To enable their B.M.I. (Body Mass Index) to be established and nutritional needs catered for.

Q Why use the WATERLOW pressure ulcer prevention/treatment
policy card ?

A It includes the most effective pressure sore/ulcer risk assessment scoring system - especially when used as part of a pressure sore prevention policy. It allocates 3 risk status categories which can be used by an assessor in formulating a cost effective care plan.

Q Why download or buy a hard copy of the Manual?

A It provides simple to understand causes of pressure ulcers, and a guide to the prevention of extremely debilitating and expensive pressure ulcers.

Q Why was Waterlow changed and were the changes validated by research?

A Waterlow was updated as a result of a 5 year research project conducted by Queensland Health, in which I participated.

A presentation of the Project will be made by the Project Director, a Director of Nursing based at Prince Charles Hospital Brisbane at the Australian Wound Management Association Conference in March 2006.