WAASP Nutritional Risk Screening Calculator
Score each section and sum for total. Interpretation: 0–2 Low, 3–6 Moderate, 7+ High. Use clinical judgement.
WAASP sections
Select the highest score that applies in each section.
1) Weight / weight loss (incl. BMI)
2) Appetite (current)
3) Ability to eat (current)
4) Stress factor
5) Pressure ulcer / wound
Dietitian referral triggers (irrespective of score)
Tick any that apply to highlight “refer regardless” in the interpretation.
WAASP is the All-Wales Adult Nutritional Risk Assessment (nutritional risk screening tool) used in adult inpatient settings in NHS Wales to help staff identify patients who may be at risk of malnutrition and trigger appropriate actions (care plans, monitoring, and referral).
What WAASP stands for (the 5 screened areas)
WAASP looks at five practical areas that commonly signal nutritional risk in hospital:
- Weight / recent unintentional weight loss (including low BMI)
- Appetite (current intake)
- Ability to eat (current ability to take food/fluids)
- Stress factor (illness/surgery/conditions raising nutritional needs)
- Pressure ulcer / wound status
How scoring works
- You select the highest applicable score in each section, then add them up to get a total WAASP score.
- The tool uses weighted points (some items score 0, 1, 2, 3, 4, or 7) depending on severity—for example:
- Weight: no weight loss (0), ~3 kg loss (2), ≥6 kg loss / cachexia / BMI < 18.5 (7)
- Appetite: good (0) → reduced (1) → poor (3) → little/none or refuses (4)
- Ability to eat: normal (0) → needs help (1) → GI intolerance/chewing/swallowing problems (4) → NBM > 5 days (7)
- Stress factor: uncomplicated condition (0) → moderate stress (2) → high stress (4) → very high stress (7)
- Pressure ulcer/wound: intact/healthy (0) → Cat 1–2 / low exudate (2) → Cat 3 / infected/dehisced (4) → Cat 4/open abdomen (7)
Interpreting the total WAASP score
WAASP groups patients into 3 risk bands with suggested actions:
- 0–2: Low risk
Re-screen in 1 week (or sooner if condition changes). - 3–6: Moderate risk
Support food/fluid intake (meal choice support, encouragement/assistance), snacks/milky drinks, monitor intake (All-Wales Food Record Chart), initiate local care plans, and re-screen in 1 week or sooner. - 7+: High risk
Refer to the Dietitian, plus all Moderate-risk actions; monitor intake and re-screen in 1 week or sooner.
Important safety note in the WAASP guidance: referral to Dietitian should be made irrespective of score if the patient is receiving enteral/parenteral nutrition, reports prescribed nutritional supplements on admission, or has a new therapeutic diet (e.g., gluten free, Type 1 diabetic).
