Risk Assessment Tool



Risk Assessment Tool

Introduction

This paper is primarily concerned with answering the questions 'are risk assessment scales (RASs) valid and reliable?' and 'which of these clinical judgement and RASs are superior?' The path to answering these related questions commences with an introduction to the subject area, then describes the three most common RASs. Other reviews of RASs are then described to show the gap in knowledge which this review explores. To evaluate validity the items included in RASs are next identified and how these are used to compute an overall score.

Waterlow score

The Waterlow score was designed as a practical aid to the preventive aids and treatments available whilst at the same time promoting awareness of the causes of PUs and determined risk (Waterlow 1996). The Waterlow score is composed of the following risk areas; build/weight, continence, skin type, mobility, sex/age, appetite, tissue malnutrition, neurological deficit, surgery/trauma, specific medication and additional risk factors (such as smoking). The higher the score, the higher the risk of PU formation.



The Braden score

Around the same time as Waterlow devised her score, a further assessment tool, the Braden score, was being developed based upon the literature exploring the aetiology of PU formation. Braden and Bergstrom found the critical factors to be intensity and duration of pressure and tolerance to pressure (Braden & Bergstrom 1987). Other risk factors such as mobility, skin moisture and nutritional status were also incorporated. Each sub-scale has three to four levels all with an operational definition (Braden & Bergstrom 1987).

Reviews of RASs

There are many reviews of RASs (Thompson 2005). These reviews compare and contrast the various RASs, but there is no RAS that is clearly the best. As of 2005, there were over 40 different assessment tools (Bergstrom Net al, 1995). In part, the proliferation of RASs is because of the differing needs of different clinical areas; for example, neither the Waterlow nor Braden (both designed for hospital patients) seems to be suitable for wheelchair users in the community (Anthony et al. 1998). However, even in specific clinical areas, there is no agreed best RAS; for example, in paediatrics there are several competing RASs, and eight published risk assessment tools have been identified (Anthony, Clark & Dallender 2000). While some validation studies have been performed on the more common RASs, there are few studies that compare the RASs on the same population.

For example Waterlow has responded to some of ...