Pressure ulcers are believed to largely be preventable, but in order to make best use of both human and physical resources, and maintain patient comfort and dignity, it is important to identify the people most at risk and deliver timely preventative care. Many ‘tools’ have been developed that purport to identify those who are most at risk; some of these are used generically across all patient groups, others are targeted to specific subgroups of patients; but all have some shortcomings. Clinical judgement should always be a key element of assessing a patient’s risk but this can be difficult to articulate and document. Newer ways of identifying at-risk areas rather than at-risk patients are just starting to be developed and used.