1. Tissue Viability Good Preventative Practice Helen Harris Tissue Viability Nurse Specialist

2. 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

3. 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

4. Pressure ulcers Incontinence dermatitis General skin care Tissue Viability - Prevention

5. Pressure ulcer prevention Grade 3 and 4 threshold for safeguarding Multiple grade 2’s considered Multiple patients in one setting

6. 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

7. 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

8. Skin assessment All risk areas Any areas of discomfort Variations in heat / moisture / firmness

9. 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

10. 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

11. Incontinence dermatitis Severe cases predominantly avoidable in a 24 hours setting Good continence management Use of appropriate barrier creams

12. 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

13. Summary Personalised care planning taking into account patient choice Evaluation of any care plans in a timely manner Clear and accurate documentation

14. Thank you Any questions?