Validity of Waterlow Scale

Topics: Bedsore, Nursing, Gangrene Pages: 10 (2974 words) Published: May 19, 2013

Sydney nursing school


Pressure ulcers are areas of localised damage to the skin and underlying tissue caused by pressure. (Stechmiller et al., 2008) Pressure ulcers still one of the most significant health problem in our hospitals today, It affects on patients quality of life patient self-image and how long they will stay in hospital then the cost of patient treatment . Moore (2005) estimate that it costs a quarter of a million euro’s per annum to manage pressure ulcers in hospital and community settings across Ireland .which allows one to take immediate actions and prevent the ulcer if possible. To support pressure ulcer risk assessment several standardized pressure ulcer risk assessment scales have been introduced and their application in clinical practice is recommended (Stechmiller et al., 2008). one of the most common scales used in our hospitals is the Waterlow scale, This scale was designed by Waterlow in 1985, from study in elderly and acute wards (waterlow,1985). The Waterlow Scale assigns believed to predispose patients towards developing pressure ulcers: build/weight, continence, skin type mobility, sex/age, appetite, tissue malnutrition, neurological deficit, surgery/trauma and specific medication. The total scores achieved within each factor are summed to derive the Waterlow score, with higher scores believed to mark greater vulnerability. (Waterlow, 1985) A score of more than 10 is classified as(at risk) between 15 to 20 as (high risk) and more than 20 as (very high risk).

This essay incorporates three major aspects with regards to the waterlow scale in respect to pressure ulcer. These aspects includes the high risk population ,the reliability /validity and advantages and disadvantages of waterlow pressure ulcer scale.

which population(s) the waterlow scale is applicable to?

Waterlow scale one of the famous scales to assess the pressure ulcer. the Waterlow Scale is the most widely used in health care settings (Thompson, 2005).and widely use with patients after surgery and trauma (orthopaedic and spinal surgery) also with patients have neurological deficits (DM,CVA) ,organs failure and in bad peripheral circulation. (waterlow,1985). When we use this tool with elderly we should know the elderly people already have bit of neurogenic deficit, weakness and continent. (cook et al.,1999). The scale used for Patients admitted to hospital or otherwise confined to a bed, chair, or wheelchair because they are at risk from developing pressure ulcers.( Anthony et al.,2000).

Researchers have identified advanced age (older than age80), low diastolic blood pressure (less than 60), increased body temperature, and poor current dietary intake of protein as important predictors of Pressure ulcer risk. Other risks that should be taken into account are peripheral vascular disease, prolonged surgery (particularly involving extracorporeal oxygenation), or intractable pain. (Schoonhoven et al., 2002)

Allman (1995) found we need to use the pressure ulcer scale for hip fracture patients who will stay on bed more than 4 days and with unconscious patients more than 5 days . Anthony et al (2000) found the elderly people more than 64 years old need pressure ulcer assessment but we need to be aware the elderly people complain from neurogenic deficits and loss of appetite. The patients who are on ventilator and complete bed rest especially in ICU unit they risk for skin breakdown, so they need monitoring and assessment to prevent any pressure ulcer. Watkinson (1996)


Through the reading to select the reliability and validity of waterlow pressure ulcer scale , the researchers suggested the waterlow scale is unreliable as method for pressure ulcer assessment. Several studies found the variance in scores because different in knowledge level not acceptable. A risk-assessment scale must be reliable regardless of the assessor. Many studies have evaluated the reliability, where two...
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