Tissue Viability

This nurse-led service provides specialist advice for the management of patients with: Complex wounds, Wound healing challenges and Pressure Ulcer prevention.

Diabetic Foot Ulcers should always be referred to Diabetic Podiatry Teams or Clinics

A member of the Tissue Viability Service (TVS) should be available to provide advice Monday to Friday (excluding Bank Holidays).

Please be aware the TVS is NOT a dressing service and therefore TVS staff do not supply wound care products or compression bandages

For Tissue Viability Service Provision documents, referral processes, response times and guidance see Tissue Viability – Intranet site. See individual pages and guidelines on TV Intranet pages for more specific advice in Primary Care Management section below.

For general enquiries and referrals from Health care professionals see email address on Tissue Viability – Intranet site

GE & RR 23.02.20

Please note different process for Adults, Children and some community areas

Who can refer

Registered Medical, Nursing and AHP healthcare professionals
Referrals will not be accepted from non-registered staff, non-NHS staff, patients or relatives.

ADULTS – NHS Locations

Who to refer:

Patients 16 years and older

Conditions:

Complex surgical wounds/dehiscence
New Grade 3 & 4 pressure ulcers (see Grading tool and Pressure Ulcer Prevention page on Intranet )
Rapidly deteriorating wound e.g. escalating wound infection, exposure of underlying structures e.g. bone, tendon, bowel.
To support assessment for specialist therapies, urgent advice/intervention, imminent hospital discharge/transfer
Long term wounds with limited progress and/or further deterioration

Who not to refer:

Patients under 16 years of age – refer to Paediatric TVN (see section below), however the paediatric service will continue to see young adults upto their 18th birthday if previously known to the service)
Patients with Diabetic Foot Ulcers should always be referred to appropriate service using the Diabetic Foot decision making tool
Patients with Specialist surgical wounds who need urgent referral back to hospital. Contact individual speciality consultants via hospital switchboard.
Patients with acute spreading cellulitis or sepsis refer direct to appropriate acute service

How to refer:

Standard process:
- All hospitals
- All GP practices
- All Practice/Treatment room nurses
- South Edinburgh and Midlothian Community Nursing teams
  
  Complete electronic referral form and email to Tissue Viability email address
eWound Clinic process:
- North Edinburgh Community Nursing teams
- East Lothian Community Nursing and Care Home teams
- West Lothian Community Nursing and Care Home teams
  
  Obtain consent, take photographs and complete eClinic electronic referral form (general wound or leg ulcer) and email to eWound Clinic email address from secure NHS email address (check eHealth ‘safe email grid’ before sending). See Intranet Site – Tissue Viability

ADULTS – Non-NHS areas e.g. Care Homes

Care Home Nursing Teams or Community Nursing services should assess and provide advice in the first instance. See TV Referral pathway for non-NHS Nursing Homes on Intranet Site – Tissue Viability
If condition/wound is not improving then the Registered Healthcare professional can refer to TV service as above for ‘Adults’.

CHILDREN

Who to refer:

Patients under 16 years old
Conditions:

ADULTS – Non-NHS areas e.g. Care Homes

CHILDREN

Who to refer:

Patients under 16 years old
Conditions:

Complex surgical wounds/dehiscence
New Grade 3 & 4 pressure ulcers
Rapidly deteriorating wound e.g. escalating wound infection, exposure of underlying structures e.g. bone, tendon, bowel.
To support assessment for specialist therapies, urgent advice/intervention, imminent hospital discharge/transfer
Long term wounds with limited progress and/or further deterioration

Who not to refer:

Patients over 16 years of age – refer to Adult TVN (see section above) (The paediatric service will continue to see young adults upto their 18th birthday if previously known to the service)
Patients with Diabetic foot ulcers refer directly – see Diabetic Foot Disease Teams or Podiatry
Patients with Specialist surgical wounds who need urgent referral back to hospital. Contact individual speciality consultants via hospital switchboard.
Patients with acute spreading cellulitis or sepsis refer direct to appropriate acute service

How to refer:

A paper referral form should be printed off, completed and sent via internal mail to: Pauline Emsley, TVN, RHSC See Intranet Site – Tissue Viability

Wound Management (General)

LJF Wound Support Material with images to aid in product selection

Dressing selection guide with photos (1st choice)
Choosing appropriate Foam or secondary dressing (1st and 2nd choice)

LJF Dressings and Bandage section – all product choices and prescribing notes

Tissue Viability Grading and Tools (Health Improvement Scotland)

Acute Wounds

Burns – Thermal injury guidelines and when to refer to regional unit
Intranet – Tissue Viability guidance on Burns
Skin tears/Lacerations – Management guidance and Educational resources
Intranet – Tissue Viability Guidance on Skins and Tears
NHS Scotland NES guidance on prevention assessment & management of Skin Tears
C-Section Wounds – Identify infection, removal of sutures/clips and dressings, patient leaflet
Intranet – Tissue Viability guidance on Surgical Wounds
Minor injuries – link tbc

Chronic and Infected wounds

Tissue Viability Management of Chronic wounds with suspected infection including algorithm for decision making (Scottish Ropper Ladder for infected wounds and Patient information leaflets)

Leg Ulcers/wounds

Refer to Lower limb – Foot and leg ulcer Decisions and Referral Pathway
Non-healing wounds on lower limb (greater than 2 weeks duration)
- Doppler ABPI Assessment and Decision Pathway – includes choosing compression therapy systems
- Leg Ulcer Assessment Chart
- Leg Ulcer competencies for assessment and applying compression

Intranet – Tissue Viability guidance on Leg Ulcers

Pressure Ulcer Prevention and Management