3.5 Identify the pressure area risk assessment tools which are used in own work area

This guide will help you answer 3.5 Identify the pressure area risk assessment tools which are used in own work area.

Pressure areas are parts of the body that are prone to damage caused by pressure or friction. These injuries are sometimes called pressure ulcers, pressure sores, or bedsores. People who find it hard to move, sit, or lie in the same position for long periods face a higher risk.

Early identification of risk helps stop sores from developing. Assessment tools help staff assess risk and support people to stay safe.

What Is a Pressure Area Risk Assessment Tool?

A pressure area risk assessment tool is a checklist or scoring system. It helps you decide if a person is at risk of developing pressure sores. It considers different aspects of a person’s health and lifestyle.

Using a tool means you check everyone in the same way, and it helps you spot problems early.

Why Use Pressure Area Risk Assessment Tools?

Pressure ulcers can cause pain, serious infection, and longer hospital stays. Preventing them is safe and cost-effective.

Risk assessment tools:

• Offer a standard way of identifying risk
• Make sure nothing is missed
• Support care planning
• Help show that good care is being provided
• Reduce harm

Common Pressure Area Risk Assessment Tools

Many assessment tools are used across different care settings. The most common ones in the UK include:

• Waterlow Score
• Braden Scale
• Norton Scale
• Purpose T Risk Assessment Tool

The choice depends on your local policy, training, and the needs of the people you support.

The Waterlow Score

The Waterlow Score is widely used in hospitals, nursing homes, and community care. It gives a score based on several factors. Staff add up points for each factor.

Main Features:

• Gives a total risk score
• Includes age, sex, and body weight
• Looks at movement, skin condition, continence, and mobility
• Checks for special risks, like underlying disease

How It Works:

Each risk area is rated 1 to 8 points. The higher the points, the greater the risk. Once added, the total indicates the level of risk:

• 10+ At risk
• 15+ High risk
• 20+ Very high risk

Extra points can be added for specific risks. For example, if the person has poor nutrition, is on certain medications, or has neurological problems.

Useful Points:

• Easy to use
• Quick to complete
• Widely recognised across the UK

Example:

If you are supporting Mr Smith who has reduced mobility, recent weight loss, and mild skin redness, you add up points for each area. His total may show medium or high risk, leading to immediate action.

The Braden Scale

The Braden Scale helps predict pressure sore risk by assessing six areas:

• Sensory perception
• Moisture
• Activity
• Mobility
• Nutrition
• Friction and shear

Each section is rated 1 to 4 (some up to 3). A lower total means more risk.

Braden Categories Explained:

1. Sensory Perception: Can the person feel and communicate discomfort?
2. Moisture: Is the skin damp from sweat, urine, or faeces?
3. Activity: How often does the person move?
4. Mobility: Can they change their position?
5. Nutrition: Does the person eat well?
6. Friction and Shear: Is there risk from sliding in bed or chair?

Cut-off Points:

• 9 or below: Very high risk
• 10–12: High risk
• 13–14: Moderate risk
• 15–18: Mild risk
• 19–23: Low risk

Advantages:

• Widely used in hospitals and international settings
• Focuses on causes, not just observation

When Used:

The Braden Scale may be used in hospital wards, care homes, or when someone is being cared for at home with district nursing support.

The Norton Scale

The Norton Scale is one of the oldest tools. It uses five areas to judge risk:

• Physical condition
• Mental condition
• Activity
• Mobility
• Incontinence

Each is graded 1 to 4, with a lower total showing higher risk.

Norton Categories:

1. Physical condition: From good to very bad
2. Mental condition: Alert to stuporous
3. Activity: Ambulatory to bedfast
4. Mobility: Full to immobile
5. Incontinence: None, occasional, or urine/faeces

How to Score:

• 20: No risk
• 15–16: Mild risk
• 13–14: Moderate risk
• 12 or below: High risk

Where Used:

Still found in some older care homes. Less common now, as other tools cover more factors.

Purpose T Risk Assessment Tool

Purpose T is a more recent tool based on the latest evidence. It has three main stages:

1. Screening: Ask if the person stays in bed/chair or cannot move easily
2. Assessment: Check skin, especially over ‘bony prominences’
3. Judgment: Decide the risk and plan prevention

Main Features:

• Simple questions
• Aimed at all staff
• Designed to prompt skilled judgment, not just ticking boxes

The Purpose T tool suits varied care settings and can help staff use their professional experience alongside checklists.

Local or Organisational Tools

Organisations may create their own risk assessment tools. These might use aspects of Waterlow, Braden, or Purpose T but add details or prompts for local needs.

Why Local Tools Exist:

• To meet organisation-specific policies
• Reflect service-user population
• Add extra checks for specific risks (such as for people with burns or particular health issues)

Any tool must be evidence-based and fit local policies. Training is provided on how and when to use them.

Digital Risk Assessment Tools

Increasingly, care services use digital systems for pressure area risk assessment. Electronic patient records store assessment results.

Benefits of Digital Tools:

• Quick calculations
• Prompts for regular assessment
• Easy access to history
• Consistent records across all shifts
• Automatic reminders

Digital versions of Waterlow, Braden, or custom checklists may be in use. Always use the system approved by your organisation.

How and When to Use Pressure Area Risk Assessment Tools

You use these tools:

• On admission to a service
• After a change in condition
• Following hospital stays
• If new wounds or sores appear
• Regularly, as set out in policy (for example, weekly or monthly)
• After a fall or period of illness

Staff record scores, follow up with care plans, and reassess as needed.

Practical Use in Own Work Area

Look at how these tools are used in your own care setting.

Example: Nursing Home

• Waterlow Score is standard on admission
• Care plan includes checklist results
• Reassessed weekly or after health changes
• Urgent review if skin dam​age is seen
• Actions: turn chart, pressure-relieving equipment, extra skin checks

Example: Hospital

• Braden Scale used in acute medical wards
• Immediate risk score after admission
• Nurses update assessment every shift
• Electronic system records findings
• Senior staff audit assessments monthly

Example: Domiciliary Care

• Care workers complete Waterlow at initial assessment
• Risk discussed with family and district nurse
• Regular checks whenever care visits take place
• Scores noted in the homecare file; team leader reviews

Who Performs the Assessment?

Usually, trained health and social care staff complete risk assessments. Training is provided so everyone scores accurately.

Roles may include:

• Registered nurses
• Healthcare assistants
• Senior care assistants
• Community carers (with nurse support)

All staff need to know:

• Which tool to use
• How to complete it
• How to note scores
• When to report concerns

Competence is checked through supervision, spot checks, and regular updates.

Factors Considered in All Tools

Most risk tools focus on common themes:

• Age
• Mobility
• Skin condition
• Nutrition and fluids
• Cognition or mental alertness
• Continence (bladder/bowel control)
• Existing illnesses

Some ask about:

• Use of medical equipment (casts, catheters, etc)
• Medications affecting skin, movement, or alertness

Staff are trained to check both what the tool asks and what their own observations show. For example, someone who is restless but keeps slipping down in bed might still have a high risk from friction, even if active.

Strengths of a Standardised Approach

• Consistent care
• Gaps or risks less likely to be missed
• Easy to share information between staff
• Reflects professional standards
• Good documentation protects staff and the person being cared for

Limits of Pressure Area Risk Assessment Tools

Checklists support staff but do not replace checking the person’s whole situation. Remember:

• Tools rely on accurate staff judgement
• Not all risks may be evident
• Reassessments are needed as people’s conditions change

You should use your own knowledge and share with senior staff if in doubt.

Reporting and Record Keeping

Always record scores, actions planned, and any concerns. This record is part of the care plan.

Good practice includes:

• Clear documentation after each assessment
• Noting any actions taken (like repositioning or equipment use)
• Reporting changes to nurses, managers, or healthcare professionals
• Promptly escalating any new signs or skin damage

Involving the Person and Their Family

Always involve the person receiving care. Explain why assessment is necessary. Ask about their health, preferences, and experience.

Share any findings with the person, and involve their family or advocates where appropriate.

Actions Following Assessment

If someone is judged “at risk”:

• Add interventions to the care plan (extra turns, creams, mattress change)
• Use monitoring charts
• Review wounds promptly
• Confirm equipment is in good working order
• Train staff on safe handling, skin care, and nutrition support

Reviewing and Auditing Use of Tools

Managers check how well staff use tools by:

• Reviewing assessment forms
• Sitting in on assessments
• Spot checks
• Auditing care records

Feedback supports ongoing training and quality care.

Final Thoughts

Pressure area risk assessment tools are important in your work. These tools act as a guide to support decision-making. Waterlow, Braden, Norton, and Purpose T are commonly used. Your own workplace will have a preferred tool. Training, regular review, and team discussion all help make sure you use the tools effectively. Accurate use means people stay safe, pain is reduced, and standards stay high.

Remember, these tools are not a replacement for your skilled care, but a support for the important work you do.