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First to dress initiative procedure

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 and associated pathways and policies version 3 (this is a live updated document).

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 Scope

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

This procedure links to the wound care and tissue viability manual.

4 Procedure

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 procedure 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 procedure 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 wound care formulary appendix H and associated pathways and policies version 3 (this is a live updated document).

Details of dressing products given in tab; first to dress initiative guidance

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 colleagues 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 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.

If any of the following red flags are identified, seek immediate guidance from registered clinician, if inpatient for single point of access for 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

It is the non-registered clinicians responsibilities to:

  • observe the wound and patient and report back to the registered clinician accurately and promptly
  • only undertake wound care as specified within competencies framework and as guided by this procedure
  • record actions accurately in the patient’s care plan using SystmOne
  • Identify training needs in relation to wound care: undertake initial education using tier 2 pressure assessment training
  • continue to seek ongoing support and education as needed to ensure safe practice
  • will follow the wound cleansing pathway and follow the wrap pack guidance

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.

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

Registered clinicians follow own code of practice.

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.
  • The Nursing and Midwifery Council Code of Professional Practice (2015).
  • The Nursing and Midwifery Council Delegation and Accountability, supplementary information to the Nursing and Midwifery Council 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

6.1 Wrap pack

Included within your wrap pack are a range of simple to apply dressing to ensure initial first to dress patient wound safety.

6.1.1 Step 1: prepare

  1. Identify the wound and select the most appropriate dressing from your wrap.
  2. Wash hands and ensure patient is comfortable.
  3. Open dressing pack, try not to handle the contents of the pack too much.
  4. Open the selected dressing onto the dressing pack, ensuring you do not touch the dressings.

6.1.2 Step 2: cleanse

  1. Use alcohol gel to decontaminate hands and apply gloves within pack.
  2. Cleanse the wound using the Irripod solution and the gauze.

6.1.3 Step 3: treat

Apply the selected dressing, ensuring you do not touch the part of the dressing which will touch the wound.

6.1.4 Suggested dressing

Suggested dressing for intact skin: Medi Derma S or Comfeel plus transparent.

Suggested dressing for broken skin: Urgotul Absorb Barrier.

6.1.5 Housebound procedure

  1. Is the patient housebound?
    • Yes: refer into single point of access for district nurse review in 5 to 7 days on 03000 218996.
    • No: refer to patients GP or practice nurse.

All dressings can remain in place for up to 7 days, however may need changing more frequently.

6.2 Would care formulary

Please see wound care and tissue viability manual webpage for appendices attached to this procedure.

  • Appendix H Doncaster community wound care formulary.

6.3 Table 1 first to dress initiative guidance

Type of wound Rationale for treatment Appropriate dressing Non-registered clinicians level of care (having assessed their competency) Registered clinician’s level of care
All type of wounds or abrasions to skin. Protection and reduced risk of infection. Prontosan solution or sterile water. Urgotul wound absorb border
dressing pack.		 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.

 Refer to appropriate service or Clinician for appropriate wound assessment.

Refer to appropriate service if required.
Excoriation of skin due to moisture or incontinence. Clean and provide protected interface. Medi Derma Spray. Medi Derma Pro Skin Ointment. 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.

 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

Document control

  • Version: 3.
  • Unique reference number: 161.
  • Ratified by: clinical effectiveness group.
  • Date approved: 10 June 2025.
  • Name of originator or author: clinical nurse specialist in tissue viability.
  • Name of responsible individual: chief nursing officer.
  • Date issued: 1 July 2025.
  • Review date: 30 July 2028.
  • Target audience: all clinical staff.
  • Description of change: predominantly wording and linking in with the Doncaster wide wound formulary and pathway.

Page last reviewed: July 03, 2025
Next review due: July 03, 2026

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