Tissue Viability Service

Tissue viability (commonly referred to as wound care) is a skilled county-wide service. We provide an integrated service across all inter-professional teams.

We provide education and support to ensure that services across Cornwall and the Isles of Scilly can deliver a high standard of care in all aspects of tissue viability management.

We provide timely access to assessment, treatment and evaluation for a range of tissue viability issues.

The team sees patients in their own homes, community hospitals, GP surgeries, and care homes.

They care for patients of all ages with a wide range of wounds. This includes pressure ulcers, leg ulcers, post-surgical wounds, and dermatological conditions.

A leg ulcer is a break in the skin below the knee which has not healed within 2 weeks. A venous leg ulcer occurs in the presence of venous disease and is the most common type of leg ulcer, accounting for 60 to 80% of cases. It typically occurs in the gaiter area of the leg (from the ankle to mid-calf).

A pressure ulcer is a localised injury to the skin and/or underlying tissue usually over a bony prominence, because of pressure or of pressure in combination with shear.

Who is ask risk of developing a pressure ulcer?

There are many risk factors for people to develop pressure ulcers which include:

• underweight or overweight people
• the elderly
• frailty score of 6 or over
• co-morbidities (such as diabetes, peripheral arterial disease, unable to reposition independently, lower limb oedema, restless legs rubbing heels, or lower limb contractures)  
• sensory impairment
• dementia
• mental illness
• incontinence

Resources

• NHS UK pressure sore information.
• Pressure ulcer information leaflet (PDF, 110 KB).

• Antimicrobial dressing tissue viability pathway (PDF, 52 KB).
• Autolytic debridement tissue viability pathway (PDF, 44 KB).
• Emollient pathway.
• Exudate tissue viability pathway (PDF, 42 KB).
• Fungating wound tissue viability pathway (PDF, 39 KB).
• Hosiery tissue viability pathway (PDF, 45 KB).
• Lower leg ulcer tissue viability pathway (PDF, 53 KB).
• Moisture associated skin damage pathway.
• MRSA tissue viability pathway (PDF, 38 KB).
• Over granulation tissue viability pathway (PDF, 37 KB).
• Skin tear management tissue viability pathway (PDF, 54 KB).
• Pressure care tissue viability pathway (PDF, 68 KB).
• Urgostart treatment tissue viability pathway for leg ulcers and diabetic foot ulcers (PDF, 58 KB).

What is PROMISE?

PROMISE stands for pressure reduction through continuous monitoring in the community setting.

The project rolls out the use of mattress and chair sensors in patient's homes, which continuously measure and record the patient's body surface pressures.

The chairs and mattresses are linked to a computer which displays the interface pressures in real time and visually identifies the areas of the body under sustained pressure

This helps the patient or carer to better understand the positions that are likely to reduce the risk of pressure ulcers.

For more information, email the PROMISE Project Team.

History of PROMISE

Led by Nicci Aylward-Wotton, Tissue Viability Nurse Consultant and PROMISE Project Lead, the Tissue Viability Team in Cornwall started using pressure mapping equipment in 2016 to pressure monitor patients in community settings.

• The project found that pressure mapping can:
  • achieve good clinical outcomes with 80% healing and healed pressure ulcers
  • reduce the number of unavoidable pressure injuries
  • reduce the number of truly non-concordant patients and medical device related pressure injuries

What is scaling-up?

Following the successful project in Cornwall, we applied to the Health Foundation to be a part of their scaling-up programme.

Led and funded by the Health Foundation, the programme supports 7 projects in the UK to take their proven health care interventions and approaches and to make them work at larger scale, resulting in a positive impact on patient outcomes.

The project was accepted onto the programme in November 2017 and the project was launched in January 2018.

Our aim

The aim of the PROMISE quality improvement project is to determine if pressure monitoring in patient's homes can inform effective management of the prevention and treatment of pressure ulcers, especially in those who are labelled as non-concordant or have a deteriorating pressure ulcer.

Our vision

Our vision is to use biofeedback to equalise the knowledge base between the practitioner and patient and enhance the therapeutic relationship, ultimately to increase patient empowerment, patient centred care and choice.

Project objectives

The Trust is the lead organisation to deliver the PROMISE project.

There are 4 clinical adopter sites:

• our Redruth District Nursing Team
• Tissue Viability Team, Live Well Plymouth Community Trust;
• Tissue Viability Team, Torbay and South Devon Community Trust;
• Somerset Partnership NHS Foundation Trust

The project has an independent evaluation partner, Cedar (Cardiff and Vale University Health Board) to undertake an evaluation of the project. Plymouth University and the University of Southampton are supporting the project and providing expert clinical and academic advice.

Leaflets

• PROMISE patient information leaflet.
• PROMISE professional information leaflet.

Resources

• Transforming Community Health research.