Skin and Wound Care

Skin is the largest organ of the body and requires daily basic care, such as cleaning and moisturising, hydration and nutrition. Care home residents are at risk of skin health issues such as skin tears, lacerations and bruising due to their ageing process, increasing frailty and a range of health conditions such as diabetes or heart failure. Residents who are confined to bed or who sit in the same position for extended periods of time are particularly vulnerable to pressure ulcers. Any skin issue or unhealed wound can have a significant impact on the resident’s wellbeing and physical health.

All wounds have a cause. When considering how to care for a resident with a wound or at risk of a wound developing it is important for care staff, the resident and their families to be aware of the cause. Not every wound can be avoided and not all wounds may heal, however preventing wound complications wherever possible and treating any avoidable skin problems quickly can significantly improve a resident’s quality of life. For example, dry skin is less resilient and more likely to tear when knocked, so daily skin care and the use of moisturisers can help reduce this risk.

Staying Well / Prevention

Some steps should be taken for all care home residents to reduce the risk of a wound developing:

Promoting a healthy lifestyle including a good diet, limited alcohol and not smoking
Managing skin health, including cleaning and using moisturisers
Maintaining good management of any long term conditions. Residents with diabetes are particularly at risk of foot issues and should have daily foot checks, known risk status and annual foot screening by GP
Wearing appropriate, well-fitting footwear
Reducing the risk of falls, to avoid injury
Good management of any continence issues
Encouraging resident to keep moving and not stay in one place for too long. Be aware that residents with foot ulcers may have restricted walking to reduce pressure/deterioration
Use any prescribed pressure relieving equipment (eg cushions) and follow repositioning plans
If the resident already has a wound follow any treatment prescribed

Residents will be more at risk of wounds occurring due to the ageing process of the body and their individual frailty, immobility and underlying health conditions. Personalised assessment and care planning will help to identify and manage resident’s individual risk levels. Residents at high risk should have a personal risk assessment in place.

In addition, staff should:

Be familiar with their home’s policy and procedures on wound care
Be proactive in identifying and resolving any wound risk concerns
Be trained in skin and wound care, and able to recognise and flag pressure ulcers and leg and foot ulcers needing further attention

Training

Wound care companies will provide face to face training in the use of their products if contacted – for example urgo, coloplast

Identification of concerns

Regular review of the condition of the skin is vital to identify changes in the persons own usual skin condition. Staff should be able to recognise and document signs that the skin looks different to normal, for example changing colour or texture, has new marks or swelling, or if there are breaks in the skin. The Legs Matter three point leg check may help for lower limbs

At first signs of a wound developing it is important to ensure all preventative steps are being taken and to actively monitor the wound for any changes. This includes any early signs of pressure ulcers. All wounds with a break to the skin should be cleaned and covered with an appropriate dressing. Care homes should have an appropriate first aid kit available. Warwickshire residential homes should follow the skin tear pathway.

ACTNOW Foot Graphics Cards with 3 different skin tones to support recognising changes in Diabetic feet that need identification and referral.

NICE guidelines advise any Diabetic foot wound to be referred to Podiatry within 24hrs of identifying. Any foot wound can also be referred to Podiatry for treatment.

Refer to national guidance for nursing homes.

Escalation and Response

If a resident has had a wound for 1-2 weeks which is not responding to appropriate first aid or prescribed care, contact the resident’s GP (nursing homes) or community / district nurse (residential homes) for review. For diabetic foot wounds do not wait but refer within 24 hours to podiatry.

If a resident has a new wound sustained from an injury such as fall which needs treatment beyond a normal dressing, or has signs of infection such as worsening pain to a wound site or local swelling, heat or discharge, contact the urgent community response / urgent and emergency care team for advice and support.

For advice and support please contact:

Coventry

All nursing home residents contact the resident’s GP
Ambulatory residents in residential homes contact the resident’s GP
Community nursing services for non ambulatory residents in residential homes on 03002000011 (option 2)
Urgent and emergency care (UEC) on 03002000011 (option 3)
Podiatry for all foot wounds within 24 hours if the resident is diabetic or for non-diabetics after 1-2 weeks if not healing in a timely way. Referral is via the resident’s GP

Warwickshire

All nursing home residents contact the resident’s GP
Ambulatory residents in residential homes contact the resident’s GP
Community nursing services for non ambulatory patients in residential homes via iSPA on 01926 600818
Urgent community response via iSPA on 01926 600818
Podiatry for all foot wounds within 24 hours if resident is diabetic or for non-diabetics after 1-2 weeks if not healing in a timely way. Referral is via an online referral form

Useful documents

General

National Wound Care strategy

Legs Matter

Ideal Diabetes

Diabetes UK

NHS guides

NICE guidelines

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