In the second of two articles on pressure area care in A&E, Nicola Wickham considers risk assessment and pressure relieving strategies

Risk assessment is an important part of preventative care. 'The vital issue is the detection of when a patient needs special measures to be implemented since this is not always apparent until too late to prevent the development of a pressure sore’ (Norton et al 1975). Risk factors arc therefore an early wanting sign. The multitude of risk factors already identified make a memory aid/ prompt necessary. There is a wide variety of risk assessment tools on the market (lidwards 1994; Flanagan 1993; Hamilton 1992), the strengths and weaknesses of which arc discussed in these papers. Perhaps the most widely used are the Norton scale (Norton et al 1975), and the Waterlow scale (Table 1). The Norton scale identifies only five main risk factors while the Waterlow scale is more comprehensive. The categories used by Norton appear ambiguous and subjective (Bridel 1993a;Flanagan 1993). Very few of the available risk assessment scales have been subjected to trials to check inter-rater reliability (Edwards 1994). Norton used only one observer in her study (Edwards 1994;Norton et al 1975).