Tissue Viability Service
“Tissue viability is a growing speciality that primarily considers all aspects of skin and soft tissue wounds including acute surgical wounds, pressure ulcers and all forms of leg ulceration.” (Tissue Viability Society, 2009).
Our tissue viability team provides specialist evidence-based advice to all health care professionals, patients, families and carers. All patients are eligible for referral to our service, if registered with a GP in the geographical boundaries of Plymouth, South Hams & West Devon (Western CCG locality) and meet the referral criteria. We receive referrals from nursing homes, residential homes, district nursing teams, GP practices and other clinical settings within Livewell Southwest. We cover a wide variety of complex wounds including the pressure ulcer prevention and management, prevention and management of leg ulceration, lymphoedema – both primary and secondary – including patients with active ulceration, management of traumatic injuries, and complex non healing wounds.
Tissue Viability Team
Theresa Mitchell – Tissue Viability Clinical Nurse Specialist (Queen’s Nurse)
Emma Hannaford Hill – Support Nurse Sister
Doreen White – Support Nurse
Sally Stroud – Support Nurse
Leanne Mallett – Assistant Practitioner
Lower limb service and achievements
Our lower limb service is an award-winning team, having set up eight wellbeing lower limb clinics across Plymouth and South Hams. We have successful healing rates of 4 – 12 weeks, treating patients with venous and arterial leg ulcers. Our model was nominated for a Health Service Journal award and received the Pride of Plymouth award in 2018 for innovation and commitment.
Other significant implementations have also been introduced to continually improve our service and the delivery of care in the community. This includes the total purchase of wound care dressings and applications, which eliminates the need to generate a prescription and avoids waiting times to receive the prescription. It provides the patient with the right dressing at the right time, reducing the risk of infection. More recently we have secured direct purchase for compression hosiery and adjustable velcro compression devices are readily available within our clinics and district nursing bases, further enabling patients to receive the most appropriate treatment in a timely manner.
A new photo app (ios spot) has been launched and is currently being piloted, which allows clinical staff to securely take photos of wounds throughout the stages of wound healing. This software is being used by several multidisciplinary teams throughout Livewell Southwest working collaboratively to achieve best practice in all wound healing.
We work closely with both the Vascular and Tissue Viability teams at University Hospitals Plymouth NHS Trust, sharing a lower limb pathway having direct access to their Vascular service. In March 2020 we were newly commissioned to offer and lead a Lymphoedema service.
Collaborative working with other multidisciplinary services
We are proud to have strong relationships working closely with many multidisciplinary teams, sharing skills and knowledge to offer best practice to all of our patients. We link together with the continence team, district nurses, practice nurses and GPs, the lower limb team, nursing homes, residential homes, podiatry, vascular service, wheelchair services, lymphoedema team, Millbrook equipment services and multiple representatives from our formulary companies.
Pressure ulcer prevention
Within our tissue viability team we offer advice, education and clinical support for pressure ulcer prevention. We also carry out holistic assessments, assist clinical staff and patients with developing pressure ulcers across community settings.
Every year we celebrate #STOPTHEPRESSURE day, actively spreading the message for people to keep moving and how to avoid a pressure ulcer occurring.
We have worked closely with NHS Cornwall Partnership Trust and implemented a quality innovation project called PROMISE continuous pressure mapping in the community. The project has now ended, however we have the benefit of keeping the pressure maps and will continue to pressure map patients within Livewell Southwest.
- Pressure ulcer prevention leaflet
- PROMISE leaflet
- 30 degree tilt leaflet
- Knee break poster
- Correct elevated leg positioning poster
The SSKIN care bundle is a powerful tool as it defines and ties best practice together. The bundle also makes the actual process of preventing pressure ulcers visible to all. This minimises variations in care practices.
Skin tear pathway
Skin tears are a traumatic injury that can occur on any anatomical location. In the elderly they are often sustained on the extremities such as the upper and lower limb, and on the dorsal aspect of the hands. An initial assessment should include a comprehensive assessment of the patient’s wound and consider their age, past medical history, general health and potential for wound healing. Please see the leaflet below for the appropriate steps to be taken when treating a skin tear.
Education and training
Knowledge is a powerful resource and there is value in education for everyone involved in preventing pressure ulcers, management of leg ulcers and all aspects of wound healing.
To see what training we offer, please check the Livewell Southwest Academy website: www.livewellswacademy.co.uk
Please call 01752 434757 to speak directly to the Tissue Viability team.