Sex/Age
| Male...................................1 Female.................................2 14-49..................................1 50-64..................................2 65-74..................................3 75-80..................................4 81+....................................5 |
| Average................................0
Poor...................................1 NG Tube/fluids only....................2 NBM/Anorexic...........................3 |
| Complete/Catheterised..................0 Occasional incontinence................1 Catheter/Incontinent of Faeces.........2 Doubly Incontinent.....................3 |
| Healthy................................0 Tissue Paper/Dry.......................1 Clammy/Oedematous......................1 Discoloured............................2 Broken Spot............................3 |
| Fully..................................0 Restless/Fidgety ......................1 Apathetic..............................2 Restricted.............................3 Inert/Traction.........................4 Chairbound.............................5 |
| Average................................0 Above Average..........................1 Obese..................................2 Below Average..........................3 |
| eg.Terminal Cachexia...................9 Cardiac Failure........................5 Peripheral Vascular Disease............5 Anaemia................................2 Smoker.................................1 |
| eg. Diabetes,CVA,MS,Paraplegia, Motor/Sensory........................4-6 |
| Steroids,Cytotoxic,Anti-inflammatory...4 |
| Orthopaedic - Below Waist, Spinal.....5 Patient on table more than 2 hours....5 |
| Total Risk Score |
| Date |