This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Pressure ulcers and who is at risk
A pressure ulcer, or pressure injury, is damage to the skin and underlying tissue caused by prolonged pressure, usually over a bone such as the sacrum, the hips or the heels. It can develop in a few hours in a person who cannot move, and it heals slowly. Most pressure ulcers can be prevented if those at risk are identified early. The Norton scale, created by Doreen Norton, Rhoda McLaren and A. N. Exton-Smith in 1962, was the first tool designed for this.
The five items
Each item is scored from 1 (worst) to 4 (best):
| Item | 4 | 3 | 2 | 1 |
|---|---|---|---|---|
| Physical condition | Good | Fair | Poor | Very bad |
| Mental condition | Alert | Apathetic | Confused | Stuporous |
| Activity | Walks unaided | Walks with help | Chairbound | Bedbound |
| Mobility | Full | Slightly limited | Very limited | Immobile |
| Incontinence | None | Occasional | Usually urine | Urine and feces |
The total ranges from 5 to 20.
Interpretation
- 15 to 20: low risk
- 13 to 14: at risk
- 12 or less: high risk
Example
A person in fair physical condition, apathetic, chairbound, with very limited mobility and occasional incontinence:
- 3 + 3 + 2 + 2 + 3 = 13, at risk
Prevention
- Reposition regularly, often every 2 to 4 hours depending on the support surface and the skin’s response, and use a 30-degree tilt rather than lying directly on the hip.
- Support surfaces: a pressure-redistributing foam or air mattress and a cushion for sitting.
- Skin care: keep the skin clean and dry, manage incontinence promptly and avoid rubbing over bony areas.
- Heels: float them off the bed with a pillow under the calves.
- Nutrition: enough calories, protein and fluids; a dietitian can help when intake is poor.
- Inspect the skin at least daily; persistent redness that does not fade when pressed is the earliest stage of a pressure injury.
Limits
The Norton scale does not include nutrition or friction and shear, which the Braden scale adds. Risk scales support, but do not replace, a full skin assessment and clinical judgment. Reassess on admission, after any change in condition and at regular intervals.