Tissue viability Resources

A skin integrity prevalence audit was conducted in two health boards in Scotland in 2022, involving 186 care homes and assessment of 6,510 residents. Data collection involved in person and online contact with care home managers and senior care staff by specialist tissue viability nurses and care home support team members. Data was analysed to
generate prevalence rates per 1,000 residents. The findings identified an overall wound rate of 138.6 per 1,000 residents and further skin integrity needs (lower limb oedema) of 79.4 per 1,000 residents. There was variation in the incidence of wounds and lower limb oedema in the two health board settings. This is the first study at this scale and serves as an important benchmark for understanding skin integrity needs in the care home sector. There are important implications for education, training and support of care home staff as well as workforce planning for specialist nursing care to ensure appropriate prevention and management of skin care for residents.

Erosive pustular dermatosis (EPD) of the leg is a rare condition that is challenging and complex to diagnose and treat. This cutaneous inflammatory disease is associated with trophic changes of the lower limb, and while its incidence is unknown, it is believed to be more common than previously thought. Care of leg ulcers poses a considerable burden to the health service, although it is estimated that only half of patients receive the appropriate treatment. This article reflects on the case of a patient with chronic ulcerated and swollen legs who was referred to a wound advisory clinic by his GP. It critically assesses the data from the patient history, physical examination and treatment decisions. It is hoped that describing this case — patient history, findings from physical examination and treatment plan — will help further community nurses’ understanding of the condition.

Managing moisture to achieve the optimum ‘moist’ wound healing environment is key to facilitating wound healing. Wounds which are dry or have a low volume of exudate need moisture added for hydration. Wounds that are wet with a high volume of exudate need fluid to be removed effectively by dressings with high absorbency. Moisture imbalance can have negative consequences for patients — physically, psychologically and socially.

Improvement of wound outcomes is a priority for the NHS if the cost of wound management is to be reduced. Failure to undertake a full holistic wound assessment can result in inappropriate and ineffective treatment, resulting in delayed healing, which can have a negative effect on patient quality of life and healthcare resources. NHS England has commissioned a CQUIN scheme for 2017–19. This comprises 13 indicators which seek to improve quality and outcomes of care for NHS
patients, while supporting local areas in delivering their sustainability and transformation partnerships (STPs). The tenth national indicator focuses on ‘improving the assessment of wounds’. This article provides a practical guide to systematic wound assessment for community nurses so that CQUIN targets can be met, and also introduces a new tool from BSN medical, an Essity company, to help nurses in this area.

Mark Collier reflects on a foreign visit in which he experienced first hand the true realities of limited resources in wound management.
Mark Collier, B.A (Hons), RNT, RCNT, ONC, RN is Lead Nurse - Tissue Viability, United Lincolnshire Hospitals NHS Trust, United Lincolnshire Hospitals Tissue Viability Collaboration (ULHTVC), c/o Pilgrim Hospital, Sibsey Road, Boston, Lincolnshire.
Article accepted for publication February 2001.

Maureen Benbow reflects on changing and current trends in relation to the emergence of the nursing specialty of tissue viability and how this has influenced the quality of patient care.
Maureen Benbow MSc, BA, RGN, HERC is Senior Lecturer at the University of Chester.
Article accepted for publication: December 2006