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Understanding Pressure Ulcer Risk Tools: An In-Depth Overview of Waterlow, Braden & PURPOSE-T


Pressure ulcers, also referred to as bedsores, present a significant challenge within healthcare settings, leading to severe complications for patients and increasing the burden on healthcare systems. Effective identification and prevention of these injuries are crucial, facilitated by several assessment tools developed to pinpoint patients at risk and guide preventive measures. This blog explores three prominent risk assessment tools—The Waterlow Score, The Braden Scale & The PURPOSE-T Framework—offering a comprehensive view of their development, application, and significance in UK clinical practice.

 

The Waterlow Scoring System

A photo of Judy Waterlow
Pictured here is Judy Waterlow

Developed in the 1980s by Judy Waterlow, the Waterlow Scoring System is foundational in assessing the risk of pressure ulcers. It accounts for a variety of factors including age, BMI, skin type, mobility, and nutritional status, providing a numerical score that categorises patients into low, moderate, or high risk for ulcer development.

 

Key Features:

The Waterlow Scoring System evaluates both intrinsic and extrinsic factors contributing to pressure ulcer risk, ensuring a comprehensive assessment. It assigns scores based on a range of patient characteristics, allowing for nuanced evaluations.

 

Advantages:

The long-standing use and holistic approach of The Waterlow Score make it a trusted tool in UK healthcare settings, recognised for its widespread adoption and effectiveness.


An Example of a Waterlow Chart
An Example of a Waterlow Chart

Limitations:

The scoring of some components like skin type and mobility can be subjective, leading to variability in results across different assessors. This tool provides a snapshot assessment, which may not reflect changes in a patient's condition over time.

 

Clinical Application:

The Waterlow Score is utilised to guide specific preventive measures tailored to each risk level, facilitating personalised patient care plans.

 

The Braden Scale

Introduced in 1987, The Braden Scale for predicting Pressure Sore risk assesses patient vulnerability to Pressure Ulcers based on six criteria: sensory perception, moisture, activity, mobility, nutrition, and friction and shear.


An Example of a Pressure Ulcer
An Example of a Pressure Ulcer

Key Features:

Each area of The Braden Scale is scored to reflect the patient's condition and potential risk, with a lower total score indicating higher risk. Its reliability and validity have led to widespread adoption across various healthcare settings.


Advantages:

The development of The Braden Scale involved rigorous testing for reliability and validity, enhancing its credibility and utility in clinical settings.

 

Limitations:

The scale may not adequately capture the nuanced risks of certain patient populations, such as those with specific medical conditions.

 

Clinical Application:

The Braden Scale guides the development of personalised care plans, influencing interventions such as repositioning schedules, dietary adjustments, and specialised mattresses.

 

The PURPOSE-T Framework

An example of a PURPOSE-T Framework
An example of a PURPOSE-T Framework

Developed from extensive international research initiated in 2009, The PURPOSE-T Framework was introduced in 2014 to improve specificity and effectiveness in pressure ulcer risk assessment and prevention.

 

Key Features:

PURPOSE-T begins with identifying at-risk patients, followed by a detailed assessment of factors such as mobility and nutrition. A colour-coded system helps clinicians develop specific primary or secondary prevention strategies.

 

Advantages:

By focusing evaluations only on those who need them, PURPOSE-T optimises care delivery and can improve patient outcomes.


Limitations:

The framework requires thorough training and an understanding of its comprehensive approach, which can be a barrier in resource-limited settings.

 

Clinical Application:

PURPOSE-T facilitates the creation of bespoke interventions, preventing ulcers in at-risk individuals and managing existing ones with greater efficacy.

 

Comparative Analysis

Each tool has its unique strengths and areas for improvement, which are crucial for their effective application in clinical settings:

 

- The Waterlow Score and PURPOSE-T stand out for their comprehensive evaluation of risk factors, whereas The Braden Scale focuses more on physical and observable criteria.

- The Braden Scale and PURPOSE-T offer robust frameworks, but The Waterlow Score provides greater flexibility in scoring, which can be both an advantage and a limitation due to its potential subjectivity.

- PURPOSE-T is specifically designed to optimise resource use, making it potentially more suitable for large-scale healthcare settings where efficiency is critical.

 

In conclusion, while The Waterlow Score, The Braden Scale, and PURPOSE-T Framework each offer significant benefits in the prevention of pressure ulcers, their effective integration into clinical practice requires careful consideration of their advantages and limitations. The choice of tool can depend on specific patient needs, healthcare setting constraints, and the desired depth of risk assessment. As healthcare continues to evolve, these tools will also need to adapt, reflecting new research and clinical practices to better serve both patients and healthcare providers in the ongoing fight against pressure ulcers.

Read More on Waterlow, Braden & PURPOSE-T


Author

Scott Harding-Lister, Director at Apex Health Associates

 

 





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