The Waterlow Score is a pressure ulcer (pressure injury) risk assessment scale developed by nurse Judy Waterlow in 1985. It’s widely used in the UK (and elsewhere) in hospitals, nursing homes, and community care to estimate how likely a patient is to develop a pressure ulcer and to guide prevention planning.

The scale looks at several risk domains, each of which receives a score based on severity. These usually include:

• Build / weight for height (BMI)
• Skin type / visual risk areas (e.g. dry, fragile, discoloured, already damaged)
• Sex and age
• Continence (urinary and faecal)
• Mobility
• Nutrition / appetite
• Special risks such as tissue malnutrition (e.g. cachexia), neurological deficit (e.g. paraplegia, stroke), and major surgery or trauma.

Each factor is given a point score, and the points are summed to give a total Waterlow Score. Higher totals mean greater risk. Typical interpretation bands are:

• < 10 – No obvious risk
• 10–14 – At risk
• 15–19 – High risk
• ≥ 20 – Very high risk

Patients at higher risk should receive targeted pressure ulcer prevention: regular repositioning, pressure-redistributing surfaces, moisture and continence management, nutritional support, and close skin inspection, in line with local policies and NICE guidance.

The exact scoring details (how many points for each condition or BMI range) are defined on the official Waterlow score card and may vary slightly in local adaptations. Clinicians should always use their organisation’s approved version.