Wirralwounds tissue viability service

The tissue viability service was first established in 1995 to provide equipment for private care homes. Today this has extended to all 360,000 residents of the Wirral in a variety of healthcare settings including private care homes, leg ulcer/wound clinics, surgeries, patients’ homes, walk-in centres and community wards. All patients receive a full assessment which in addition to assessing the wound can identify other intrinsic and extrinsic factors that may contribute to the poor healing of the wound.

Specialist provision includes:

Sources of Referral

Referrals are made to the service by:

general practitioners

hospital consultants

patients

allied healthcare professionals

nurses

nursing and residential homes

integrated discharge teams

Referrals can also be made by:

referral form

letter

fax

telephone

face to face contact

Service Provided

specialist assessment of wounds

specialist advice on normal and abnormal wound healing

specialist assessment of leg ulcers

specialist advice on use of Doppler ultrasound

specialist advice on dressing selection

specialist advice on compression therapy – theory, management, application

specialist advice on preventing recurrence

specialist health promotion advice

provision of specialist health equipment to patients receiving Funded Nursing Care (FNC) and Continuing healthcare (CHC)

The service consists of two full time tissue viability specialist nurses, but with recent amalgamation this also includes a specialist equipment nurse for private nursing homes.

Following a holistic assessment, a plan of care is formulated with the referring clinician. All specialists are supplementary prescribers which allows for the provision of treatment that can extend beyond wound dressing products e.g. analgesia and anti-microbials.

Training for community and nursing home staff is essential to ensure that personnel are fit for purpose and possess the necessary skills for the ever increasing challenges of modern wound care. The cost for wound dressing products has been estimated to be in the region of £224 million annually. With finite resources attempting to meet an infinite need, wound management needs to be cost effective. This should not be based on unit costs but in relation to the benefits to the patient. The training program provided by our service identifies the importance of nurses being aware of issues related to the cost incurred of managing chronic wounds. Service users need to receive effective treatment and care that conform to nationally agreed best practice, particularly as defined in national service frameworks and NICE guidance (standards for better health, DoH, 2004). The application of guidance and principles is embodied in a number of national directives e.g. NICE pressure Ulcer prevention and Management guidelines, 2003 and 2005. Benchmarking (Essence of care) National Service Framework for the elderly, which will impact on the provision of care in care homes.

Training and Education includes

basic wound care

chronic wound care

pressure ulcer management

2 day leg ulcer assessment and management

tissue viability link groups

10 week nursing home course

annual conference

Audit

Pressure ulcer prevalence will help determine the amount of clients with a pressure ulcer within a point of time. This will have financial implications with regards to resources such as staff time and equipment. The costs associated with managing a grade 4 (European Pressure Ulcer Advisory Panel) pressure ulcer have been estimated in the region of £498,000,000 (P. Franks 2007). Patient satisfaction questionnaires will provide feed back to measure clients’ opinion of service provision.

Database

Tissue viability clinical activity is recorded and reports provided for the trust monthly activities recorded include:

patient biographical data

TVN involved

priority of visit

duration of visit

type of wound

pressure ulcer data

current wound management details

dressing recommendations

equipment ordered (pressure relieving)

appropriate visit

review by TVN

Policy and Procedures

The TV service formulates policies and procedures that guide staff to provide evidenced based service for clients, including:

Leg Ulcer Assessment and Management Policy

Pressure Ulcer Prevention and Management Policy

Doppler procedure

Aseptic technique

Wound Policy (pending)

Documentation

The TV service have developed and evaluated documentation to support staff in assessing clients with tissue viability issues

Leg Ulcer Assessment documentation

Pressure Ulcer Assessment documentation

Wound assessment docs

Compression hosiery and Doppler docs

Evaluation of Wound dressing products

Case and clinical studies are performed by the TV service to evaluate the efficacy and cost effectiveness of new products.

Multi-disciplinary meetings

Collaboration and working with other allied health professionals, and regular meetings with other specialists to share experiences and appreciation of the diverse talents and skills within the NHS.

Newsletter

All staff are periodically provided with a newsletter with contemporary issues in wound management.

Health promotion

In addition to providing specialist advice for the management of wounds, appropriate health promotion is provided with regards to weight and lifestyle management and smoking cessation. Clients will be sign-posted for support and advice within the Wirral.

Conclusion

The Tissue Viability Service within Wirral PCT (Community) provides a specialist service to support clients and staff to manage a wide range of acute and chronic wounds. Timely referral and intervention can support clients’ care within their own home. This will reduce the need for referral for secondary care thus providing a cost effective solution to address the clients’ needs. A broad range of educational and training facilities also supports a work force fit for purpose to meet the challenges within a modern dynamic NHS.

Ian Mansell RN, DN, BSc (Hons) is specialist practitioner in tissue viability

www.Wirralwounds.nhs.uk