Tissue ViabilityGood Preventative
PracticeHelen Harris
Tissue Viability Nurse Specialist
What is Tissue Viability?
• Management and advice for service users with complex wounds
• Management of advanced therapies• Support complex pressure ulcer prevention cases• Responsible for all TV strategy, policy and
procedure
Service provision• Anyone with a complex need who is
registered with BANES or South Glos GP• 3 community hospitals• Care home support• Approx 437,000 population
• Pressure ulcers• Incontinence dermatitis• General skin care
Tissue Viability - Prevention
Pressure ulcer prevention
• Grade 3 and 4 threshold for safeguarding
• Multiple grade 2’s considered• Multiple patients in one setting
Good Preventative care• Risk assessment
• Consider reliability• Use clinical judgement• Must be re-evaluated when condition changes• Must only be a aide memoir• Poor predictor in wheelchair users and maternity• The clinician who carries out and signs the risk assessment
is responsible for devising prevention strategies
Care Planning• Care plan must be implemented for anyone
high risk to include– Outcome of risk assessment– The need for additional pressure relief at risk sites– Their mobility and ability to reposition– Co-morbidities– Patient preference
Skin assessment
• All risk areas• Any areas of discomfort• Variations in heat / moisture / firmness
Repositioning• Adults at risk should be encouraged to
reposition at least every 6 hours and high risk at least every 4 hours
• Assist those that can’t• Document the frequency of repositioning
required
Equipment• Utilise high specification foam for those
patients in hospitals / nursing homes or assessed as high risk in the community
• Use heel protectors for those at risk• Utilise dynamic systems for those where
static systems are not sufficient
Incontinence dermatitis• Severe cases predominantly avoidable in a
24 hours setting• Good continence management• Use of appropriate barrier creams
General Tissue Viability • Good skin management• Use of appropriate moisturisers• Good documentation including evaluation of
any treatment or prevention plans• Appropriate and timely referral on taking into
consideration patient choice
Summary• Personalised care planning taking into
account patient choice• Evaluation of any care plans in a timely
manner• Clear and accurate documentation
Thank youAny questions?