“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.
We received a Certificate of Excellence in 2024 from iWantGreatCare, which was awarded in recognition of consistently outstanding patient feedback.
Tissue Viability Team
Hannah Blake, Tissue Viability Clinical Nurse Specialist, MSc Wound Healing and Tissue Repair
Emma Hannaford-Hill, Tissue Viability Sister
Bethany Money, Tissue Viability support nurse
Leanne Mallett, Tissue Viability Assistant Practitioner
Janay Wills. Lower Limb Specialist Nurse
Sunneva Coyne-Stacey, Lower Limb Specialist Nurse
Lower limb specialist service
Our Specialist Lower Limb Nurses work collaboratively with the district nursing teams to fulfil the National Wound Care Strategy’s aim of providing comprehensive lower limb assessment of housebound patients within 14 days of presentation of a lower limb wound. We aim to provide specialist care in the form of compression therapy to heal leg wounds as quickly as possible and to refer to onward services promptly where required.
The Tissue Viability team work closely with the Lower limb service which have clinics set up across the Plymouth and South Hams area. Every year we celebrate #LegsMatterWeek.
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 and NRS 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 are currently working in partnership with the SEAMLESS project: Transforming Community Health project which builds on earlier work using pressure mapping equipment to monitor patients in community settings.
Leaflets
- Pressure ulcer prevention 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 promote gold standard evidence-based practice, employees of Livewell Southwest are advised to attend the relevant training for their job role.
Although it is not compulsory, it is recommended to refresh your knowledge every 3 years to stay up to date with the best available practice.
The training sessions available are:
Wound management and dressing selection
Aims
- To recognise the factors and barriers to wound healing
- To use a holistic approach and involve the patient in their carers
- To understand the importance of wound assessment and review
- To gain a basic knowledge of the topical applications/dressings available and provide a rationale for their use
- To recognise infection
Objectives
- The course will cover the wound healing cascade, Wound Bed Classification, Infection Continuum and Recognising infection, Dressing Selection and Group Work. A selection of dressings and topical applications will be displayed throughout the session.
Summary
- This course provides an overview of wound management and in addition covers dressings/topical applications used in wound management. It is designed for all registered nurses, nurse practitioners, nurse associates and healthcare professionals. The course provides information regarding all dressings and topical applications within the local Wound Care Formulary.
Pressure ulcer prevention and management
Aims
- Attendees will develop their knowledge and skills in the Prevention and Management of Pressure Ulcers including risk assessment, classification of Pressure Ulcers, reporting, documentation and accountability as well as equipment selection and group work. Attendees will be asked to complete a pre and post-test quiz to demonstrate evidence of learning. Nurses are required to work through Livewell Southwest Pressure Ulcer Competencies to be deemed competent.
Objectives
- Risk Assessment Classification of Pressure Ulcers, reporting, documentation, accountability , equipment selection , group work
Summary
- Develop your knowledge and skills in the Prevention and Management of Pressure Ulcers, through learning about reporting, equipment selection and risk assessment.
Lower limb management training for healthcare assistants - Two day course
Aims
- Understand the anatomy and physiology
- Identify the blood vessels of the lower limb
- Understand leg ulcer aetiologies
- Understand the functions of the skin and the wound healing cascade, recognising infection
- Understand the principles of Doppler Ultrasound and Holistic Doppler assessment.
Objectives
Day 1
- Discuss the legal, financial and humanitarian costs of leg ulcers
- Identify the key blood vessels of the lower limb
- Understand the differences between arteries and veins of the lower limb
- Identify common causes of leg ulceration
- Understand importance of holistic assessment
- Identify risk factors associated with the development of arterial and venous leg ulcers
- Describe the pathological conditions that contribute towards venous and arterial ulcers
- Recognise the signs and symptoms of venous and arterial ulcers
- Understand principles of arterial and venous ulcer management
- Recognise other types of lower limb ulceration
- Discuss strategies to reduce the risk of recurrence
Day 2
- Discuss the theory of graduated compression therapy
- State the principles of Laplaces Law
- Apply the general principles of good bandaging technique
- State the advantages/disadvantages of each system
- State the contraindications for compression therapy
- Demonstrate the practical skills required for the application of compression therapy
- Doppler Theory Rationale
- The principle of Doppler Ultrasound Selection of equipment
- Preparation of the patients Measuring the ABPI
- Calculating the results Re-examination Factors affecting the ABPI
- Summary
- Conclusion
Summary
This is a 2 day course and provides an introduction to Lower Limb Care. The course covers holistic assessment and management of the Lower Limb.
The first day covers anatomy and physiology and the 2nd day focusses on holistic assessment and interpretation of the Ankle Brachial Pressure Index (ABPI).
The course is for registered nurses who are consistently delivering care to patients with Lower Limb Disease.
Following completion of the course you will be required to work through a competency framework to be deemed competent in applying compression therapy and undertaking holistic Doppler Assessment.
Lower limb management training for healthcare assistants - One day course
Aims
- Identify the key blood vessels of the lower limb
- Understand the differences between arteries and veins of the lower limb
- Identify common causes of leg ulceration
- Identify risk factors associated with the development of arterial and venous leg ulcers
- Understand principles of arterial and venous ulcer management
Objectives
- Discuss the legal, financial and humanitarian costs of leg ulcers
- Describe the pathological conditions that contribute towards venous and arterial ulcers
- Recognise the signs and symptoms of venous and arterial ulcers
- Discuss strategies to reduce the risk of recurrence
- Discuss the theory of graduated compression therapy
- Apply the general principles of good bandaging technique
- State the advantages/disadvantages of each system State the contraindications for compression therapy
- Demonstrate the practical skills required for the application of compression therapy
Summary
- This is a one day course for HCA’s. It provides an introduction to Lower Limb Care. The course covers the management of the Lower Limb conditions.
- The morning session covers anatomy and physiology and the afternoon consists of workshops for the application of compression bandaging, aimed at HCA’s who are consistently delivering care to patients with Lower Limb Disease.
- Following completion of the course you will be required to work through a competency framework to be deemed competent in applying compression therapy.
If you are external to Livewell Southwest and would like to book on any of these training courses or find out more please contact: [email protected]
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Contact
Please call 01752 434757 to speak directly to the Tissue Viability team.