Contents
1 Introduction
The aim of this procedure is to provide guidance for registered clinician and non-registered clinicians within the trust on the selection and application of appropriate dressings for wound care at first contact or under delegation. The first to dress initiative is to be activated at the first contact with a housebound patient, patient attending clinic, needle exchange, day hospital or newly admitted to inpatient area that requires a wound dressing. This procedure reflects a multidisciplinary approach to the tissue viability and wound management and follows the Doncaster community wound care formulary (opens in new window). This procedure is to ensure that patient centred wound care within the trust is provided both safely and cost effectively. To standardise wound care practice for first contact breaches in skin integrity.
2 Purpose
This procedure is intended for use predominantly in the community, Tickhill Road Hospital site in-patient services and provides guidance for other patient areas covered by the trust. However, it may also be relevant for all other in-patient services. In the North Lincolnshire and Rotherham localities tissue viability and wound care services is provided by North Lincolnshire and Goole NHS Foundation Trust and Rotherham NHS Foundation Trust. The tissue viability and wound care services provided are a combined hospital and community service
3 Link to overarching policy
4 Procedure or implementation
The purpose of this procedure is to ensure the application of the appropriate wound care dressing at first encounter of breach of skin integrity and, or when priorities for wound healing change and to ensure there is no delay in supplying the appropriate wound dressing product. The policy acknowledges creating an environment whereby clinicians are actively involved in ensuring that quality, as well as proven, cost effective treatments are incorporated into the care delivered and they are accountable for that care. The policy is not intended as a substitute for professional judgement but in support of the clinicians making an informed decision relating to the wound management at first contact, guided by the Doncaster community wound care formulary (opens in new window). Details of dressing products given in Table 1 First to dress initiative guidance.
| All type of wounds or abrasions to skin | Excoriation of skin due to moisture or incontinence | |
|---|---|---|
| Rationale for treatment | Protection and reduced risk of infection | Clean and provide protected interface |
| Appropriate dressing | Prontosan solution Urgotul wound absorb border dressing pack | ProShield foam and spray ProShield Plus |
| Non-registered clinicians level of care (having assessed their competency) | Apply Prontosan solution as per wound cleansing pathway Urgotul wound absorb border and dressing pack refer to appropriate service or clinician as an inpatient for appropriate wound assessment | Follow skin care pathway for moisture associated dermatitis (MASD) or incontinence associated dermatitis (IAD) primary care refer to appropriate service or clinician as an inpatient for appropriate wound assessment |
| Registered clinician’s level of care | Refer to appropriate service or clinician as an inpatient for appropriate wound assessment | Review at dressing change and re-establish dressing regime review care plan to minimise leakage follow skin care pathway for moisture associated dermatitis (MASD) or incontinence associated dermatitis (IAD) primary care |
4.1 Non-registered clinicians
The first to dress initiative allows for non-registered clinicians to apply, in defined situations, a first dressing from the core bag dressing supplies for community staff and ward stock for in-patient areas. The supply of dressings beyond this will be subject to assessment by a registered clinician.
The first to dress initiative can be activated at first contact with a housebound patient, patient attending clinic or hospital setting that requires a wound dressing for:
- trauma wound presenting as an abrasion or skin tear
- pressure damage presenting as a category 1 or category 2 pressure ulcer
- skin reaction to dressing produce
- skin trauma on removal of dressing product
- excoriation of skin from urinary or faecal incontinence or wound exudates
- leg ulcer care, where there is strike through of exudate through all layer of bandages
- surgical wound when a patient has been discharged from hospital with no or inadequate supply of dressing
- injection site trauma as misses or abscess formation.
Non-registered clinicians must report the first contact episode and full details of the breach of skin integrity and their action at the earliest opportunity either at report handover or by mobile phone or by SystmOne task before the end of the shift.
Patients should be referred immediately for further examination to a registered clinician if an inpatient or an appropriate service:
- nature and extent of the injury is uncertain
- there is a history of head injury or the patient reports loss of consciousness
- there is persistent bleeding
- suturing is required
- foreign body is present in the wound
- tetanus prophylaxis maybe required
- there is any uncertainty of the appropriate management
- there is deterioration in the wound
It is the non-registered clinicians responsibilities to:
- undertake wound care as delegated by the registered clinician in the patient’s care plan
- read and understand the patient’s care plan prior to carrying out the delegated task
- observe the wound and patient and report back to the registered nurse accurately and promptly
- only undertake wound care as specified within competencies framework and as directed by the appropriate service
- record actions accurately in the patient’s care plan using the electronic patient record or SystmOne
- identify training needs in relation to wound care, undertake initial education using wound care training session
- completion of the wound care on integrated pathway of care (IPoC)
- continue to seek ongoing support and education as needed to ensure safe practice
- Non-Registered Clinicians undertaking wound care will have completed competencies in:
- aseptic technique
- will follow the wound cleansing pathway and apply Urgotul absorbent border dressing to reduce risk of infection.
4.2 Registered clinician responsibilities
The first to dress Initiative allows for a registered clinician to apply a first dressing and the first change of dressing without the need for a prescription. This may be at either first contact or where a different dressing product is required as a result of changes to the wound. supply of dressings beyond this will be from the Doncaster community wound care formulary (opens in new window).
Registered clinicians must only work within their competency.
4.3 Infection control
The first to dress dressing stock will be part of the core bags for all community clinicians and dressing cupboards for inpatient areas, should be kept in according to the trust infection prevention and control specifically waste management.
4.4 Professional accountability
4.4.1 Community
Supplies for community staff will be available in the central dressing cupboard at Tickhill Road Hospital.
4.4.2 Inpatient areas
First to dress initiative dressings in the inpatients’ areas are ordered via NHS supply chain or formulised localised arrangements.
5 References
- Beldon P (2014) Wound Management can seem to be complicated. Wound Care Today Vol 1 No 1 10 to 18.
- Guest IF, Ayoub N, McIlwraith T et al. (2017) Health economic burden that different wound types impose on the UKs National Health Service Int. Wounds Jn14 (2): 322 to 30.
- Harrison M (2006) Discussion on Wound Care in the 21st Century British Journal of Nursing Volume 15 No. S12 to S16
- International Consensus (2013) making the case for cost effective wound management.
- Mahoney K (2015) How to choose the correct dressing Wound Care Today Vol 2. Number 1. 8 to 13.
- NMC Code of Professional Practice (2015).
- NMC Delegation and Accountability, supplementary information to NMC Code (consultation April to July 2018, part of new register January 2019).
- Vernon Moore Collier (2021) Development and integration of a wound cleansing pathway into clinical practice. BJN volume 30, number 20 Tissue Viability Supplement.
- Wounds International (2018) Best Practice Recommendations for the
Prevention and Management of Skin Tears in Aged Skin. - Wounds UK (2018) best practice statement: improving holistic assessment of chronic wounds. London.
- Wounds UK (2020) Best Practice Statement: Post-operative wound care, reducing the risk of surgical site infection.
- Wounds UK (2017) Quick guides: TIMES model of wound bed preparation.
- Young T (2017) Back to basics: understanding moisture, associated skin damage . Wounds UK volume 13: No 2: 56 to 65.
6 Appendices
Please see wound care and tissue viability manual webpage for appendices attached to this procedure.
- Appendix H Doncaster community wound care formulary.
Document control
- Version: 2.1.
- Unique reference number: 161.
- Approved by: Clinical policies review and approval group.
- Date approved: 1 February 2022.
- Name of originator or author: Clinical nurse specialist in tissue viability.
- Name of responsible individual: Clinical nurse specialist in tissue viability.
- Date issued: 23 September 2022.
- Review date: March 2025.
- Target audience: All clinical staff.
- Description of change: Minor amendment, correction to appendix number.
Page last reviewed: April 24, 2024
Next review due: April 24, 2025