Pressure ulcer risk · Updated October 2026
Waterlow assessment score calculator
Work out a Waterlow score in a few taps. Choose the options that apply in each section of the Waterlow chart to see the total score, the pressure ulcer risk level and a prevention plan you can copy into care notes.
For guidance only. The Waterlow score supports, but does not replace, clinical judgement and a full skin assessment. Nothing you enter is saved or sent anywhere.
What is the Waterlow assessment score?
The Waterlow score is a pressure ulcer risk assessment tool used in hospitals, care homes and community nursing across the UK. It was developed by Judy Waterlow in 1985 and revised in 2005.
The Waterlow assessment adds together scores for a person’s build, continence, skin type, mobility, sex, age and nutrition, plus any special risks such as poor circulation, neurological conditions, major surgery or certain medicines. The higher the score, the higher the risk of developing a pressure ulcer.
Free download
Waterlow pressure ulcer risk record (PDF)
A printable Waterlow assessment record to complete on paper, track scores over time and keep in care notes.
How to use the Waterlow calculator
- 1Score the 7 main sectionsChoose one option for build, continence, mobility, sex and age. For skin type, choose all that apply. You can enter height and weight to work out BMI.
- 2Complete the MSTAnswer the malnutrition screening questions about weight loss and appetite.
- 3Add special risksTick any that apply, such as organ failure, neurological deficit, surgery or medication.
- 4Record and actCopy the summary into care notes, start the prevention plan, and set a date to reassess.
Waterlow chart: scoring guide
The full Waterlow chart, showing the score for each item. In skin type and the special risks, more than one item can be scored.
| Section | Item | Score |
|---|---|---|
| Build (BMI) | Average, BMI 20 to 24.9 | 0 |
| Above average, BMI 25 to 29.9 | 1 | |
| Obese, BMI 30 or more | 2 | |
| Below average, BMI under 20 | 3 | |
| Continence | Complete or catheterised | 0 |
| Urinary incontinence | 1 | |
| Faecal incontinence | 2 | |
| Urinary and faecal incontinence | 3 | |
| Skin type | Healthy | 0 |
| Tissue paper, dry, oedematous, or clammy and pyrexia | 1 | |
| Discoloured (category 1) | 2 | |
| Broken or spots (category 2 to 4) | 3 | |
| Mobility | Fully mobile | 0 |
| Restless or fidgety | 1 | |
| Apathetic | 2 | |
| Restricted | 3 | |
| Bedbound | 4 | |
| Chairbound | 5 | |
| Sex | Male | 1 |
| Female | 2 | |
| Age | 14 to 49 | 1 |
| 50 to 64 | 2 | |
| 65 to 74 | 3 | |
| 75 to 80 | 4 | |
| 81 and over | 5 | |
| Malnutrition screening tool | Weight loss: 0.5 to 5kg | 1 |
| Weight loss: 5 to 10kg | 2 | |
| Weight loss: 10 to 15kg | 3 | |
| Weight loss: more than 15kg | 4 | |
| Weight loss unsure | 2 | |
| Eating poorly or lack of appetite | 1 | |
| Tissue malnutrition | Terminal cachexia or multiple organ failure | 8 |
| Single organ failure or peripheral vascular disease | 5 | |
| Anaemia (Hb under 8) | 2 | |
| Smoking | 1 | |
| Neurological deficit | Diabetes, MS, stroke, motor or sensory loss, paraplegia | 4 to 6 |
| Major surgery or trauma | Orthopaedic or spinal | 5 |
| On table over 2 hours | 5 | |
| On table over 6 hours | 8 | |
| Medication | Cytotoxics, long-term or high-dose steroids, anti-inflammatories | Up to 4 |
What the Waterlow score means
Under 10: not at risk
Continue usual care, check skin during personal care, and reassess if anything changes.
10 to 14: at risk
Start a pressure ulcer prevention plan, with a high-specification foam mattress and regular changes of position.
15 to 19: high risk
Increase repositioning, check skin at every turn, and consider referral to the tissue viability nurse.
20 and over: very high risk
Consider a dynamic mattress, refer to tissue viability, and review the plan often.
Waterlow score example
Margaret, 83, lives in a care home. She is chairbound, has urinary incontinence and dry skin, and has lost about 6kg in the last few months.
- 0Build: average BMI
- 1Continence: urinary incontinence
- 1Skin: dry
- 5Mobility: chairbound
- 2Sex: female
- 5Age: 81 and over
- 2MST: 5 to 10kg weight loss, eating normally
Margaret’s Waterlow score is 16, which means high risk. Staff provide a high-specification foam mattress and cushion, help her change position at least every 4 hours, use barrier cream, and check her skin at each change of position. Her MST score is 2, so the team keeps a close eye on her weight and appetite.
Preventing pressure ulcers: the SSKIN bundle
Many NHS and care services use the SSKIN bundle to plan pressure ulcer prevention.
Surface
Make sure the person has the right mattress and cushion for their level of risk.
Skin inspection
Check pressure areas regularly, especially heels, sacrum, hips and elbows.
Keep moving
Encourage and help the person to change position regularly.
Incontinence and moisture
Keep skin clean and dry, and use barrier products where needed.
Nutrition and hydration
Support a good diet and regular drinks, and refer people at risk of malnutrition.
When to complete a Waterlow assessment
- On admission to hospital or a care home, or at the first community visit, ideally within 6 hours.
- At least weekly while the person is at risk, or as set out in your local policy.
- Whenever the person’s condition changes, such as after surgery, a fall, new illness or reduced mobility.
- Before and after transfer between services.
Other pressure ulcer risk assessment tools
| Tool | Best for | How it works |
|---|---|---|
| Waterlow score | Adults in hospital and community care, especially in the UK | Build, continence, skin, mobility, sex, age, nutrition and special risks. 10+ at risk |
| Braden Scale | Hospital and care homes, widely used worldwide | 6 areas scored 1 to 4 (or 1 to 3). 18 or less means at risk; lower scores mean higher risk |
| Norton Scale | Older adults | 5 areas scored 1 to 4. 14 or less means at risk |
| PURPOSE T | Adult inpatients and community, used across many NHS trusts | A structured, evidence-based tool that sorts people into “not currently at risk” or “at risk” |
| Glamorgan Scale | Children | Mobility, equipment, nutrition and other factors. 10+ at risk |
NICE guidance (CG179) recommends using a validated risk assessment tool alongside clinical judgement, rather than relying on a score alone.
About this Waterlow calculator
- Scoring follows the 2005 revised Waterlow pressure ulcer risk assessment chart.
- Skin type and tissue malnutrition scores are added together when more than one applies.
- Neurological deficit is scored 4, 5 or 6 depending on severity, based on clinical judgement.
- The prevention plan gives general guidance. Always follow your local pressure ulcer policy and the person’s care plan.
- Nothing you enter is saved. Avoid entering names or other personal details.
Frequently asked questions about the Waterlow score
What is the Waterlow assessment score?
The Waterlow score is a pressure ulcer risk assessment tool developed by Judy Waterlow in 1985 and revised in 2005. It adds scores for build, continence, skin type, mobility, sex, age, nutrition and special risks to estimate how likely a person is to develop a pressure ulcer.
What is a high Waterlow score?
A Waterlow score of 10 or more means the person is at risk, 15 or more means high risk, and 20 or more means very high risk of developing a pressure ulcer.
What is a normal Waterlow score?
A score under 10 means the person is not currently considered at risk. Everyone should still have their skin checked and be reassessed if their condition changes.
How often should a Waterlow assessment be done?
Complete a Waterlow assessment on admission or at the first visit, ideally within 6 hours, then reassess at least weekly and whenever the person’s condition changes, such as after surgery, illness or a fall.
How do you calculate a Waterlow score?
Choose the score that applies in each section of the Waterlow chart, add any special risks, and add all the scores together. This Waterlow calculator does the adding for you.
Can you score more than one item in a Waterlow section?
Yes, in some sections. Skin type and tissue malnutrition can have more than one item scored, and the scores are added together. Choose only one option for build, continence, mobility, sex and age.
What is the MST in the Waterlow chart?
The malnutrition screening tool (MST) is part of the Waterlow chart. It asks about recent weight loss and poor appetite. An MST score over 2 means the person should have a full nutritional assessment.
Is the Waterlow score still used in the NHS?
Yes, many NHS trusts and care homes still use the Waterlow score. Some have moved to other tools, such as PURPOSE T. Always follow your organisation’s policy.
Is there a free Waterlow assessment form?
Yes. You can download our free Waterlow pressure ulcer risk record (PDF) to print and use on paper.
Is my information saved?
No. Your answers stay in your browser and are cleared when you leave the page. Avoid entering names or other personal details.