The Core Team: Nurses and Carers
Nurses are the primary administrators of the Waterlow assessment in a hospital setting, where it is often completed upon admission as a routine part of a patient's care plan. As frontline healthcare providers, nurses are best positioned to observe and assess the various factors that contribute to a patient's risk profile, such as skin condition, mobility, and nutritional status. Their training equips them with the skills to accurately score the patient and interpret the results to inform immediate care decisions.
For patients receiving care outside of a hospital, such as in a care home or in their own home (domiciliary care), trained carers and other care staff are also responsible for performing the Waterlow assessment. These professionals work at the "patient/client interface" and use the tool to help devise effective care plans, which may include frequent repositioning or using pressure-relieving devices. Regular reassessment by these individuals is crucial, as a patient's condition and risk level can change over time.
The Expanded Team: Other Healthcare Professionals
While nurses and carers are central to the process, a Waterlow assessment can involve a wider multidisciplinary team, especially for complex or high-risk cases. This ensures a holistic and comprehensive approach to risk management.
- Occupational Therapists (OTs): OTs can use the Waterlow score to inform their recommendations for specialist equipment. For example, a high score might justify the need for a pressure-relieving mattress, a specialist seating cushion, or other mobility aids to reduce the risk of pressure injuries.
- Dietitians: As nutritional status is a component of the Waterlow score, dietitians may be involved in creating a care plan to improve a patient's diet and support skin integrity, particularly for those who are malnourished or have specific dietary deficiencies.
- Physiotherapists: A physiotherapist's assessment of a patient's mobility and ability to reposition themselves can also feed into the Waterlow score. They can work with the patient to improve mobility and reduce immobility, a significant risk factor for pressure ulcers.
When to Perform a Waterlow Assessment
A Waterlow assessment is not a one-time event; it is a dynamic process that must be repeated at key intervals to be effective. The timing of the assessment is critical for identifying and mitigating risks in a timely manner.
- On Admission: The initial assessment should take place as soon as possible after a person is admitted to a hospital or care home, often within the first 6 to 8 hours. This prompt assessment allows for immediate preventative action to be implemented for at-risk individuals.
- During a Home Visit: For domiciliary care, the initial Waterlow assessment should be completed on the first home visit.
- Regular Reassessment: The Waterlow score should be repeated regularly according to local procedures and whenever there is a significant change in the individual's condition, such as a deterioration in health, a change in mobility, or a hospital stay.
Comparison of Assessment Roles
| Professional Role | Typical Setting | Key Actions Based on Assessment | Training and Expertise |
|---|---|---|---|
| Nurses | Hospitals, Care Homes | Identify risk on admission, implement nursing interventions (e.g., repositioning schedules, skin care), communicate risk levels to the team. | Clinical training; skilled in interpreting risk factors and developing clinical care plans. |
| Carers | Care Homes, Domiciliary Care | Assist with regular repositioning, use pressure-relieving devices, conduct ongoing skin checks, and document changes to inform the care team. | Care-specific training; focuses on practical application of the score in daily care routines. |
| Occupational Therapists | Hospitals, Community | Recommend specialized equipment like cushions and mattresses to reduce pressure risk, based on the patient's mobility and seating needs. | Specialized training in functional assessments and equipment prescription. |
| Physiotherapists | Hospitals, Community | Devise and implement mobility and exercise plans to improve patient movement and reduce immobility-related risk factors. | Specialized training in movement science and rehabilitation. |
Supporting Clinical Judgment
Although the Waterlow score is a structured and valuable tool, it is not a substitute for clinical judgment. Experienced healthcare professionals use their expertise to assess individual cases and consider nuanced factors that the scoring system alone may not capture. The tool is designed to act as a catalyst for discussion and action, standardising the assessment process and providing a clear, objective starting point for interventions. For example, a nurse might override the score's basic recommendation if their professional assessment of a patient's overall health indicates a higher or lower risk than the score suggests. This collaborative and informed approach ensures that care is both evidence-based and tailored to the individual's unique needs.
Conclusion
In conclusion, a Waterlow assessment should be performed by any trained healthcare or social care professional who works directly with patients at risk of developing pressure ulcers. This includes nurses, carers, and allied health professionals such as occupational therapists and dietitians. The assessment is not a solitary task but a coordinated effort, particularly in complex cases, to ensure comprehensive and proactive care. The initial assessment is a crucial part of the admission process, with regular reassessments necessary to monitor changes in a patient's condition. While the scoring provides a standardized framework, it is the informed clinical judgment of the care team that ultimately leads to effective preventative care and better patient outcomes.
