In alignment with best practice in pressure area care and prevention, the Frimley Health Foundation Trust will adopt the PURPOSE T risk assessment tool in place of the Waterlow Score for all women receiving maternity care.

While it is recognised that the majority of pregnant and postnatal women are typically ambulant and self-caring, their clinical condition may change rapidly during the course of their care. Therefore, all women admitted to the maternity unit, or those receiving care at home births, must have a PURPOSE T risk assessment completed as part of their initial admission process.

• Within 6 hours of admission to the maternity unit or at the commencement of care for a home birth.

• At 24 hours post-admission, and then every 72 hours thereafter, or more frequently as the woman's clinical condition dictates.

• In labour, a PURPOSE T risk assessment must be undertaken:

• At the onset of labour

• Whenever there is a significant change in condition, such as the insertion of an epidural or the onset of reduced mobility.

• Women with significantly reduced mobility, including those with an epidural in situ, must have hourly skin assessments and PURPOSE T reviews during the period of immobility.

All category pressure injuries should have the following: -

• documentation in Epic - added to the Avatar body map.

• A clear image taken with informed consent, using the Epic rover.

• An incident form completed.

• Consider if a safeguarding is required for cat 3s and 4s or multiple cat 1s.

Category 1 and 2 pressure injuries should be managed at ward level with a strict repositioning regime as instructed in the Primary Intervention Care Plan that will be activated by Purpose-T.

Category 3 and 4 pressure Injuries in addition to the above, need to be referred to the Tissue Viability Team, (TVN) which is done via Epic orders.

If midwifery staff are concerned or unsure of the relevant categorisation they should take a clear image of the wound bed, and complete an online referral to TVN made through Epic - the TVN will be able to advise remotely if required (available Monday – Friday)

This addendum ensures consistent and proactive pressure area care across all maternity settings and supports early identification and management of pressure ulcer risks

National Institute for Health and Care Excellence [NICE] (2024) How should I assess a person's risk of developing a pressure ulcer? Available at: https://cks.nice.org.uk/topics/pressure-ulcers/diagnosis/risk-assessment/ (Accessed: 09 October 2025).

National Wound Care Strategy Programme (2023) Pressure Ulcer Recommendations and Clinical Pathway. Available at: https://www.oxfordhealth.nhs.uk/wp-content/uploads/sites/51/2025/01/NWCSP-PU-Clinical-Recommendations-and-pathway-final-24.10.23.pdf (Accessed: 09 October 2025).

NHS Scotland (2022) Pressure ulcers - prevention and management (G075). Available at: https://rightdecisions.scot.nhs.uk/nhs-ayrshire-arran-guidelines/clinical-guidelines/patient-care/pressure-ulcers-prevention-and-management-g075/ (Accessed: 09 October 2025).

Rotherham Doncaster and South Humber (2025) Pressure ulcers, prevention, detection and treatment procedure. Available at: https://www.rdash.nhs.uk/policies/pressure-ulcers-prevention-detection-and-treatment-procedure/ (Accessed: 09 October 2025).

Shropshire Community Health (2024) Pressure Ulcer Prevention and Management. Available at: https://www.oxfordhealth.nhs.uk/wp-content/uploads/sites/51/2025/01/NWCSP-PU-Clinical-Recommendations-and-pathway-final-24.10.23.pdf (Accessed: 09 October 2025).

Coleman, S. (2024) ‘Using PURPOSE-T in clinical practice: A realist evaluation’, Journal of Tissue Viability, 33(4), pp. 672-680. Available at: https://doi.org/10.1016/j.jtv.2024.06.014 (Accessed: 09 October 2025).

Fletcher, J. (2023) ‘Use of PURPOSE-T in practice: an evidence-based pressure ulcer risk assessment tool’. Wounds UK, 19(1). Available at: https://wounds-uk.com/journal-articles/use-of-purpose-t-in-practice-an-evidence-based-pressure-ulcer-risk-assessment-tool/ (Accessed: 09 October 2025).

NHS Doncaster and Bassetlaw Teaching Hospital NHS Foundation Trust (no date) PURPOSE T Pressure Ulcer Risk Assessment Mattress Selection Guide at DBTH. Available at: https://www.dbth.nhs.uk/wp-content/uploads/2024/03/DBTH-Pressure-Ulcer-Prevention-Mattress-Selection-Guide-2024-1.pdf (Accessed: 09 October 2025).

NHS Doncaster and Bassetlaw Teaching Hospital NHS Foundation Trust (no date) Red Care Plan at DBTH. Available at: https://www.dbth.nhs.uk/wp-content/uploads/2024/04/aSSKINg-Red-Care-Plan.pdf (Accessed: 09 October 2025).

NHS Wales (2020) PURPOSE T Pressure ulcer risk assessment. Available at: https://dhcw.nhs.wales/data/information-standards/data-standards/data-standards-files/nursing-documentation-docs/rsk-allwales-purposetpressureulcer-paperform-v2-1-pdf-1-pdf/ (Accessed: 09 October 2025).

Krisner, R. S. et al. (2025) ‘Pressure Injury of the Skin and Soft Tissue’, in DynaMed. EBSCO Information Services. Available at: https://www.dynamed.com/condition/pressure-injury-of-the-skin-and-soft-tissue (Accessed: 09 October 2025).

This guideline has been registered with the Trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt, contact a senior colleague or expert. Caution is advised when using guidelines after the review date.

This guideline is for use in Frimley Health NHS Foundation Trust hospitals only. Any use outside this location will not be supported by the Trust and will be at the risk of the individual using it.

Version History

Related Documents