Tissue Viability Newsletter Spring May 2020

Nicci Aylward-Wotton (Nurse Consultant) Pip Williams (Podiatry Specialist)

Latitia Butler (TV Clinical Specialist Nurse Bank 2 days a week)

Laura Cuff (TV Clinical Nurse)

Sally Shenton (TV Clinical Nurse)

Eileen Rytel (TV Nurse)

Charley Griffin (TV Assistant Practitioner)

Tamzin Fraser (Administrator)

There have been changes to the training format in view of the current situation, if you require any advice related to training please contact the CFT training department

on: cft.educationandtraining@nhs.net

LEGS Matter Conference Pressure Ulcer Themes and up-

TV Team News 1

TV hotline 2

Heel prevention 3

Tissue Viability Themes 4

Conatrane Update 5

Resources 6-9

Tissue Viability Fun zone 10

Inside this issue:

Tissue Viability Team News

The tissue viability team would like to wish a fond farewell to Steph Gulliver who has returned to the Camborne Community Nurses to help out in during the current situation.

The team would like to welcome 3rd Year Student Nurse Jo Phillips to the team.

Due to the current restrictions, the community tissue viability team have had to cancel the Legs Matter

conference that was due to take place on 5th June 2020.

Please ensure that when you refer a patient that the CFT referral form is completed. If you do not have an up to date copy of this please contact the TV office for a copy

Please be aware that the office is currently not manned. Please continue to leave messages these will be retrieved at regular intervals throughout the day between the hours of 0930-1600. Any messages left after

1600 will be actioned the following working day.

Contact the team by:

Tel: 01208 834371

Email: tissue.viabilitycornwall@nhs.net

Hotline: 01208 834371 (12-2pm M-F)

Contact us if you have any quick questions relating

to patient care. If you require more detailed advice

please ensure a full referral is sent to the tissue

viability email address

(tissue.viabilitycornwall@nhs.net)

Available Monday to Friday (excluding Bank holidays

12pm-2pm

Contact Bodmin Switchboard 01208 834371

Examples:

Risk Factors: Immobility/reduced mobility Reduced dietary intake /dehydration Age Sensory deficiency Comorbidities (stroke, diabetes) Pressure/friction/shear forces Reduced circulation /

ischemia/ PAD Orthopaedic surgery End of life Oedema

Assessment Ensure full PMH completed lower limb assessment Doppler Pressure ulcer risk assessment Remove devices/stockings and

inspect heels and feet for warmth, heat, bogginess, Capillary refill

Document skin integrity Complete skin bundles Observe signs of infection

Management offload the heels at all times Ensure correctly fitted and

demonstrate use to carers and/or family

Encourage repositioning Skin care regime Prevent friction injury to patients

by applying a film dressing Educate on carers/patient on

repositioning

Keep heels offloaded

Name the location:

ensure the location of

the wound is

recorded consistently

If the surrounding pressure

ulcer is red please ensure that

you check that this is blanch-

ing or non blanching and

record this in the notes

When completing incident reports

(CFT/Kernow) for pressure damage

please ensure that you record where

the pressure ulcer developed not

which team discovered the pressure

damage

Don’t forget to re

assess the patient

when the condition

changes. Think of the

RED flags

Please inform TV if the wound has

deteriorated. Wards, Nursing homes

and practice nurses please send to TV

email and for community nursing

teams upload photos to RIO and email

TV to inform us that they are available

to view. You do not need to send

photos to TV if the wound is healing.

Complete the wound

assessment regularly to

ensure that progress is

monitored. Is the wound

healing, is the wound static,

is the wound deteriorating

THINK Has the patient had a Change in Condition: Continence Pain Skin Condition / Marking Weight Loss / Nutrition Intake Mental / Psychological Health Professionals involved Equipment needs Setting of Care / Change in own Home Treatment Frailty Score

Record current equipment in

place in the equipment

template (RIO) or at the front of

the care plan (wards/nursing

homes/Practice nurses)

PN’s to consider areas on the

lower leg that are non healing

think could this be related to

pressure. Incident report on

Kernow health reporting

system .

Conatrane 100g is currently not available due to stock issues Conatrane 500g is hopefully available at the end of May 2020

Alternatives whilst Conatrane not available

Zerolon

Drapolene

Information available on the Cornwall and isles of Scilly joint

formulary website

https://www.eclipsesolutions.org/Cornwall/info.aspx?

Due to the environmental factors relating to Covid 19 we have compiled a list of resources for patient and carers that may be self

isolating Here are the links to the Patient/carer information guides

Medi resources To support you and encourage your patients to self-manage where possible, medi have a range of products available. Such as UCS debridement; juxta devices, leg ulcer kits and compression hosiery with different applicator aides. All medi referral forms are available on our medi website https://www.mediuk.co.uk/drug-tariff/ however, to make things easier, we have compiled a list of our most useful resources in one place (see bottom of page for video links). This may be useful to share with your colleagues.

Skin Care self-management UCS Debridement UCS Trudie Young video – https://stdpharm-my.sharepoint.com/:v:/g/personal/cbusek_mediuk_co_uk/EVs0LS2ciilDjOLPnwVPwfcBQPJywKatqwTn-L0jWaGWUA?e=whOnyR UCS Animation video - https://stdpharm-my.sharepoint.com/:v:/g/personal/

cbusek_mediuk_co_uk/EUE4SIclkOxKliiv_xc-dYgBFU7U2m_ekT7A6ptFTHUuvg?e=xOonDM Compression self-management Juxta devices Juxtalite Video: How to apply the juxta lite https://www.youtube.com/watch?v=j8OJSbJ4Hlg Juxta Cures Patient information leaflet: https://images.medi.de/Storage/Documents/UK/Juxtacures-patient-information-booklet.pdf Video: how to measure, cut, fit and apply the juxta cures https://www.mediuk.co.uk/drug-tariff/wound-care/juxtacures/ Juxtafit Video: How to apply the juxtafit interlocking ankle foot wrap https://vimeo.com/133425095 Video: How to apply the juxtafit lower legging https://www.youtube.com/watch?v=ekYU9QgEebM Video: How to apply the juxtafit upper leg with knee https://vimeo.com/133426424

Compression Hosiery Hosiery Application Video: https://www.youtube.com/watch?v=-5XFh2mC7Bk Medi Butler applicator Video: https://www.mediuk.co.uk/service/instructional-videos/ Med 2in1 donning and doffing applicator Leaflet: https://images.medi.de/Storage/Documents/UK/2in1_instructions_donning_and_doffing_UK.pdf Video: https://www.youtube.com/watch?v=nLnmpsec8n0&feature=youtu.be Video: https://www.youtube.com/watch?v=L1AuwrznD8w&feature=youtu.be

Dermal:

https://www.diomedgroup.co.uk/dermal-laboratories/patientresources.html

L& R

https://www.youtube.com/watch?v=rbzSpYsT57Y&list=PLozeqSijiaChZXnuRUghcG0kranu8_WPl&index=1

https://lohmann-rauscher.co.uk/quicklinks

https://lohmann-rauscher.co.uk/quicklinks/self-care

https://lrselfcare.co.uk/blog/top-tips-to-support-the-application-of-compression

https://lrselfcare.co.uk/

Urgomedical

Dressings applications and compression application available on: https://www.youtube.com/channel/UCTPoq7Ioqdp6id0PuCv5WmQ

Convatec

We have some electronic resources available that we can email to you if needed for patients who are self care using Aquacel foam, Aquacel extra, Aquacel Ag+ Extra.

Flenhealth

We have some electronic resources on self care application

Medi care plus

Application of medi derm a s cream and film:

https://medicareplus.co.uk/wp-content/uploads/2020/03/Medi-Derma-S-Cream-and-Film-Instructions-for-use-guide.pdf

Lymphoedema

Access to patient information leaflets on compression and skin care and exercises

https://www.royalcornwall.nhs.uk/services/therapies/occupational-therapy/lymphoedema/ -

Links for health care professionals for CPD

Chronic oedema in primary care https://www.jcn.co.uk/facebook-live-chronic-oedema-best-practice Diabetes and the effect on the lower limb— managing and preventing

Diabetic foot ulcers https://www.jcn.co.uk/facebook-live-diabetic-foot-ulcers Promoting self care in the management of leg ulceration https://www.jcn.co.uk/facebook-live-leg-ulceration-self-care Taking the fear out of wound infection: conquering every day issues https://www.jcn.co.uk/facebook-live-wound-infection Working together to tackle biofilms and wound infection https://www.jcn.co.uk/facebook-live-biofilms

Guess the phrase

1. 2. 3.

Ankle Brachial Pressure Index (ABPI): The ABPI is the ratio of the systolic blood pressure measured at the ankle to that measured at the brachial artery. This is used to rule out peripheral arterial disease. APBI should be completed for all lower leg wounds in conjunction with a full assessment to ensure a safe level of compression

Biofilm:

This consists of a single bacterial

or fungal species or can contain

multiple species. A biofilm can be

described as a micro-organism

that is embedded in a thick, slimy

barrier of sugars and proteins.

This can affect wound healing.

Name the location of the

potential pressure areas

Answer:1. Wound Assessment 2. Wound infection 3. 30 degree tilt