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The normal physiology of wound healing is impacted by sickle cell disease (SCD). With SCD, the red blood cells are misshapen due to an abnormality of haemoglobin S. Sickle cell leg ulcers usually occur around the ankle and have very poor healing rates, with a detrimental impact on quality of life, particularly as they usually develop in patients who are in their 20s (Marti-Carvajal et al, 2021). This article looks at some of the treatment options for SCD and whether these treatments have an impact, either positively or to the detriment of leg ulcer/wound healing. There are multiple physiological factors influencing the development of sickle cell leg ulcers, and their [ABSTRACT FROM AUTHOR]

The European Wound Management Association (EWMA) 2020 Level Seven curriculum recommends the provision of training on sharp debridement, primarily targeting specialist practitioners in wound care. Given the current lack of regulation for wound specialists in the UK, the quality and fidelity of training play a crucial role in health professionals' confidence when performing sharp debridement. Consequently, it is vital that training aids and methods accurately represent the realities of this procedure. Existing literature outlines training approaches using animal tissue or grapefruit models for sharp debridement. The University of Salford has developed a new simulation aid to teach tissue viability students about sharp debridement. This article details the development process and the creation of this innovative training aid designed to support sharp debridement education. The proposed simulation aid enables accurate representation of various wound tissue types requiring debridement in clinical settings, while eliminating the production of organic waste and the need for animal products, which may be objectionable to some learners. [ABSTRACT FROM AUTHOR]

Background: The National Wound Care Strategy Programme states there are a number of unwarranted variations within wound care across the UK leading to elongated healing times, heightened patient suffering, escalation of costs and increased burden to wound care services. There has been discussion and exploration surrounding the lack of equity across the UK in relation to practitioners being able to access to tissue viability skills and knowledge. The Tissue Viability Leading Change Framework (TVLC) is a framework to assist healthcare practitioners, and those aspiring to work in tissue viability/wound care, to understand the skills and knowledge required in this specialist area of care. TVLC includes 13 different capabilities presented on an online platform. To ascertain which of the 13 capabilities was deemed most important to the user, a survey was distributed to a group of clinicians during the Wounds UK annual conference 2022 aiming to gain greater understanding of the needs and focus of clinical practitioners currently working within the field of wound care. Declaration of interest: The creation of TVLC Framework was supported by an unrestricted educational grant from Urgo Medical. [ABSTRACT FROM AUTHOR]

Historically, information such as protocols and treatment pathways from specialist teams were shared with ward staff in paper format which proved cumbersome and difficult to update. Improvements were made with the addition of an intranet site, where protocols could be stored and accessed by clinical staff, however it was recognised that navigating the intranet site was not always straightforward and took up precious nursing time. The tissue viability team at the Royal United Hospitals NHS Foundation Trust (RUH) considered how such information might be made more readily available to clinicians. Inspired by widespread increased use of QR codes in public places during the COVID-19 pandemic, the team produced a poster containing multiple QR codes, enabling clinical staff to have instant access to wound care protocols as soon as the information was needed. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 51-year-old female with raised body mass index (BMI). Topics include emergency department experienced of swelling, severe pain, and erythema across the abdomen having no significant past medical history; and X-ray showing a perforated sigmoid causing abscess, leaking into the abdominal wall tissue causing necrotising fasciitis.

With advances in wound care and an increasing number of clinicians with the knowledge and skills in relation to tissue viability (TV) and wound management, we can diagnose and treat more complex wounds which would have previously required a hospital admission (Harrison, 2015). As a nurse-led team we found that haematomas were not being treated efficiently in the community, with patients often being sent to the acute setting for assessment and requiring surgery. As a TV team, it was deemed that we could manage these patients more effectively and appropriately in the community with early assessment and intervention of appropriate treatment. This may reduce the number of patients requiring surgical intervention and hospital admissions as well as associated costs. This led us to create a new community-based pathway for haematoma management. Previous treatment and management of haematomas in the local area was explored to ascertain effectiveness. This highlighted a gap in knowledge of the diagnosis of haematomas and delays in effective wound bed preparation. To address this as a team we explored primary dressing options and trialled a hydro-responsive wound dressing (HydroClean® advance) on 4 patients with a haematoma to their lower limb. We found that the dressing softened the haematoma, reduced pain, and prepared the wound bed for conservative sharp debridement (CSD). This article discusses in more detail the challenges of managing haematoma treatment and the development of a treatment pathway. [ABSTRACT FROM AUTHOR]

The original Tissue Viability Leading Change (TVLC) competency framework developed by clinical experts, academics and in partnership with URGO Medical 2016, has been widely implemented and used across the UK. Health professionals have used the framework to benchmark their knowledge/skills and clinical capability, while simultaneously identifying individual learning needs for continuous professional development. The TVLC Capability Framework has also been used to scope requirements of tissue viability/wound care services, allowing workforce analysis, thereby aiding the sustainability of associated services. The provision of wound care services continues to evolve across healthcare, with increased pressure on the overall workforce, an increased reliance on the non-registered workforce, the need to reduce spend and the ongoing challenges of individuals meeting continued professional development requirements. To help solve some of these challenges the TVLC Capability Framework has been updated and digitalised to ensure it remains reflective of current challenges. [ABSTRACT FROM AUTHOR]

The article provides an answer to a question concerning What are the most common areas affected by hidradenitis suppurativa.

This paper presents a reflection of my journey as a patient following a breast abscess. As an experienced community nurse with a specialist interest in tissue viability, we daily assess a range of different wound types and are adept at early identification and management of an infected wound. We instinctively know which dressing type to use to manage localised wound infection and slough and reduce pain for patients; however, when the nurse becomes the patient with a wound and has welcomed a new born child into the world, we can suddenly lose the specialist knowledge. This paper reflects on a journey I recently experienced. [ABSTRACT FROM AUTHOR]

The article presents the discussion on NHS Tayside acknowledging the need for an expert team and service to support tissue viability across the region of Tayside. Topics include funding was secured to initially advertise for five Tissue Viability Nurses (TVN) to support both acute and community hospitals; and setting up of a team email address, as well as scrutiny around Information Governance processes.

The author explains the Black, Asian and minority ethnic (BAME) patient care shared decision-making council she established with healthcare professionals to address issues influencing the inequalities in health outcomes for these patients. Topics include the author's personal experience with assessment of pressure ulcers in dark skin tones when her mother was hospitalized and her thoughts on the Best Practice Statement on addressing skin tone bias in wound care published by "Wounds UK."

The article presents a debate on how paediatric patients be cared for by paediatric tissue viability nurses. Topics include child's age and stage of development and can be an over riding factor in the planning and delivery of their care; and wound care may be directed by the local tissue viability nurse, who is probably an adult trained registered nurse will minimal exposure to or experience of caring for children.

Like many sectors, tissue viability services have been affected by and had to learn lessons from the COVID-19 pandemic. The pandemic has had an impact on service delivery and patient communication, and there has been some debate over whether this will permanently change the ways in which care is delivered. A group of specialist nurses and academics working in wound care met online via Zoom on 15th June 2021 to discuss how care has evolved since the start of the pandemic, and what this might look like as we move forward. This builds on a previous discussion that took place one year earlier (18th June 2020), in which a similar group discussed the challenges of delivering care at the height of the pandemic, which was published in Wounds UK in September 2020 (Fletcher et al, 2020). [ABSTRACT FROM AUTHOR]

The article presents the highlights of the online meeting by specialist Tissue Viability Nurses in Great Britain on June 18, 2020. Topics included the challenges faced by the nurses in their delivery of care during the COVID-19 pandemic, how the nurses resolved the issues like the use of remote video services, and the impact of the pandemic on the reported number of pressure ulcers (PU) and deep tissue injuries.

Recent increases in the population with a high body mass index (BMI) mean that individuals with bariatric care needs are an emerging population. Excess weight leads to internal physiological changes, combining with external factors such as difficulties with skin hygiene, equipment and positioning, heightening the risk of skin breakdown. Most commonly these are moisture lesions and pressure ulcers, often difficult to access within skin folds. A key challenge for clinicians is the lack of a robust evidence base to guide care once breakdown has occurred. This article gives an overview of the challenges professionals face when caring for this at-risk group, including practical suggestions for care-providers. The need for further research with this under-served population is highlighted. [ABSTRACT FROM AUTHOR]

Delivering high-quality leg ulcer care has never been more challenging, especially amid a growing patient population. Approximately 33% of wounds are leg ulcers and only 16% of those with a foot or leg ulcer had their ankle--brachial pressure measured (Guest et al, 2015). In a time where there are drivers to bring healthcare away from the hospital setting, there is increasing pressure on community nursing to conduct wound care. This article describes a project supported by partnership working to establish tissue viability (TV)-specific Band 6 roles at Hertfordshire Community NHS Trust to support improved wound and leg ulcer management in the community. [ABSTRACT FROM AUTHOR]

The role of the Tissue Viability Specialist is complex, encompassing not only effective, evidence-based clinical skills, but also competent leadership and management skills that enhance the ability to develop and implement successful business planning. The Tissue Viability Leading Change: Business Skills Development Module offered at the University of Huddersfield provides learners with knowledge and skills to understand business planning and change management. To date, 28 learners have completed the module and 100% have stated they would recommend the module to others. Participants acquired transferable skills and feel competent in developing a business case. [ABSTRACT FROM AUTHOR]

The article focuses on role and responsibilities of the Tissue Viability Nurse (TVN) for establishing an accurate diagnosis. It mentions treatment plan is practical for those delivering the care, monitoring the effectiveness of care using objective methods, liaising with other healthcare professionals and facilitating an optimal standard of care and arranging an appropriate follow-up care. It also mentions creating uncertainties about the specific responsibilities of the position.

While there are policy and government forces for positive change within the NHS, there are concerns regarding the national NHS workforce crisis (The Health Foundation, Kings Fund and The Nuffield Trust, 2018). The number of community nurses has fallen by 14% since 2009, with District Nurses falling even further at 45%. Staff recruitment and retention is a national and local priority (Health Education England, 2017), especially for community nursing. By partnering with wound care companies, two pilots to upskill staff in wound care were conducted to support improved wound management for community patients. Project 1, to up-skill Band 4 Healthcare Assistants (HCAs), and Project 2, to establish tissue viability (TV)- specific Band 6 roles at Hertfordshire Community NHS Trust. This article focuses on Project 1, a subsequent article will detail the method and outcomes of Project 2. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis is a systemic condition that is thought to have genetic and environmental components and is more common in females and older people. It causes inflammation of the joints and erosion of the bone. Patients can experience associated problems including vasculitis, ulceration, delayed wound healing, foot deformity, neuropathy, limitations in activities of daily living and impaired quality of life. Treatment with medication can increase patients' functional status but may result in delayed wound healing (disease-modifying anti-rheumatic drugs), an increased risk of skin tears (corticosteroids) or infection (biological therapies). A multidisciplinary approach is needed to educate, screen and manage patients. There is currently no optimal approach to managing patients with rheumatoid arthritis and ulcers, so prevention is key. [ABSTRACT FROM AUTHOR]

Acute and chronic wounds place a huge burden on patients and healthcare settings, so the timely resolution of complications arising from infections such as cellulitis is important. The patient (an employee of ConvaTec Ltd) suffered a left shin insect bite that developed into cellulitis with systemic symptoms. Despite successful treatment of the cellulitis with intravenous antibiotics, a circumferential wound developed with local blistering and heavy colonisation suspected. Wound dressings were applied in the acute and community setting, but debridement was not conducted, and the wound deteriorated to necrosis. Excision and skin grafts were planned, but a protocol of care was initiated comprising sharp debridement and moistened AQUACEL® Ag+ Extra™ dressing. The dressing helped to manage bioburden, aided debridement and facilitated wound healing. Surgery and additional treatment costs were avoided, and the patient was discharged. This case study highlights the need for improved access to wound care technologies for all healthcare staff. Such access can improve patient experiences and outcomes while controlling the significant costs associated with wound care. [ABSTRACT FROM AUTHOR]

This paper presents the results of an online survey that investigated healthcare professionals' knowledge of wound debridement and the techniques used. The survey, using purposive sampling, was distributed to healthcare professionals working within tissue viability services (n=252) via Survey Monkey across the UK to investigate healthcare professionals' knowledge of wound debridement and the techniques used. Response rate was 31% representing 77 participants practicing in wound care within various healthcare organisations throughout the UK. The majority of respondents (72; 93.5%) reported that they debrided wounds with seventy one respondents (95.9%) reporting they were aware of the TIME concept of which 52 stated they used TIME in their wound management approach. The findings demonstrate that healthcare professionals are aware of the importance of preparing the wound bed for the healing process with the majority of respondents using the TIME (Tissue, Infection/Inflammation, Moisture, Epithelial Edges) concept to support their assessment of wounds. However the knowledge of wound debridement was limited. There was no consensus regarding whether or not health professionals recognised the differences between the terms desloughing and debridement. The majority of healthcare professionals identified time and lack of knowledge and skills as barriers to effective wound debridement techniques. [ABSTRACT FROM AUTHOR]

With increasing health service cutbacks, cost-effectiveness is a central issue in many wound care decisions. Community nurses face expanding case-loads and earlier patient discharge into the community, with a range of conditions, which means that cost-effective, practical, clinically-effective solutions are at a premium. Clinicians are frequently required to justify clinical decision making in terms of health benefits obtained and the cost to health service providers. However, few clinicians have the skills to accurately interpret cost in more than local health economic terms, and the disjointed structures that exist in healthcare provision mean that even those who monitor health expenditure have little concept of the global cost of care provision. This article focuses on the pressures placed on healthcare providers to achieve cost-effectiveness in care, specifically in relation to wound care. [ABSTRACT FROM AUTHOR]

Traditionally, emergency departments (EDs) provide initial lifesaving treatments, but basic patient care is not always a priority. Aims of the authors' ED were to gain 100% completion of the Exeter Pressure Risk Assessment Tool — a tool designed to prevent tissue damage during a patient's stay in ED — and ensure that every patient has the pressure-relieving equipment they require while they are in the ED. Over the past 18 months, there has been a massive change in attitude and culture towards caring for patients' skin within the authors' ED. [ABSTRACT FROM AUTHOR]

Healthcare is under increasing pressure to reduce costs while maintaining the highest standard of care (Department of Health [DH], 2010). As tissue viability is multidisciplinary, demonstrating cost-effectiveness and clinical excellence can be problematic (Harding, 2000). There may be inconsistencies in treatment methods, monitoring techniques and outcome criteria across the team that impact on best practice. Keeping up-to-date, accurate records of consultations, interventions and outcomes is essential to good management and to maintaining high quality patient care. This article reviews MedICUs Tissue Viability (Mela Solutions), a networked database designed specifically to support integrated, multidisciplinary tissue viability teams. [ABSTRACT FROM AUTHOR]