The Prevention and Management of Skin Tears and Lacerations

Transcription

1 The Prevention and Management of Skin Tears and Lacerations

2 The prevention and management of skin tears and lacerations Document Type Unique Identifier Document Purpose Document Author Target Audience Responsible Group(s) Clinical Guidelines CL-140 To ensure core standards of good practice for the prevention and management of skin tears and lacerations Jackie Stephen-Haynes Professor and Consultant Nurse in Tissue Viability WHCT Staff who are involved in the prevention and management of skin tears and lacerations Clinical Policies Group Date Ratified April 23 rd 2014 Expiry Date April 23 rd 2017 The validity of this policy is only assured when viewed via the Worcestershire Health and Care NHS Trust website (hacw.nhs.uk.). If this document is printed into hard copy or saved to another location, its validity must be checked against the unique identifier number on the internet version. The internet version is the definitive version. If you would like this document in other languages or formats (i.e. large print), please contact the Communications Team on or to The prevention and management of skin tears and lacerations

3 CONTRIBUTION LIST Key individuals involved in developing the document Name Designation Jackie Stephen-Haynes Professor and Consultant Nurse in Tissue Viability Lisa Battersby Honorary Tissue Viability Specialist Nurse Michelle Greenwood Lead Tissue Viability Specialist Nurse Rosie Callaghan Tissue Viability Specialist Nurse Circulated to the following people for comment Name Michelle Allen Dani Atkinson Carrie Banks Judy Belcher Carol Bennett Andrea Carroll Amanda Cassell Claire Clayton Lynn Cox Dee Davies Sarah Degville Nikki Farrell Trisha Futers Caroline Gaynor Alison Glover Kathryn Greenwood Michelle Hill Jane Hipwell Pippa Humble Jayne Humphries Mary James Sue Jones Charlotte Jordon Debbie Keelor Mandy Lawrence Ann Lofthouse Karen Mann Claire Mason Jola Merrick Denise Moore Julie Money Deva Mooten Lorraine Newton Rachel Nichols Designation Community Staff Nurse, Abbottswood Medical Centre Community Staff Nurse, Abbottswood Medical Centre Community Staff Nurse, Albany House Surgery Tissue Viability Nurse, Acute Trust Community Staff Nurse, Riverside Surgery District Nurse Team Leader, Hagley Surgery Community Staff Nurse, Malvern Wound Care Nurse, Alexandra Hospital Practice Nurse, Churchfields Surgery, Bromsgrove District Nurse Team Leader, Knightwick Surgery Practice Nurse, Riverside Surgery Community Staff Nurse, Thorneloe Surgery Staff Nurse, Evesham Hospital Practice Nurse, Spa Medical Centre District Nurse Team Leader, The Dow Surgery Lead Nurse, Evesham Hospital Community Staff Nurse, St. Saviours Surgery District Nurse Team Leader, Crossgates House District Nurse Team Leader, Winyates District Nurse Team Leader, Cluster B, Redditch District Nurse Team Leader, Elbury Moor Medical Centre Community Staff Nurse, Shrubbery Avenue District Nurse Team Leader, Broadway Surgery Sister, Malvern Community Hospital Staff Nurse, Bredon Ward, Evesham Hospital District Nurse Team Leader Team 19, Catshill Clinic Staff Nurse, MIU, POWCH Community Staff Nurse, Bewdley and Forest Glades Clinical Nurse Manager, Herons Nursing Home District Nurse Team Leader, Ombersley Surgery Community Staff Nurse, Elbury Moor Medical Centre Staff Nurse, Clent Ward, POWCH Community Staff Nurse, Stourport Health Centre Community Staff Nurse, Haresfield House Surgery The Prevention and Management of Skins Tears and Lacerations Page 1 of 20

4 Elizabeth Nutland Rebecca O Sullivan Claire Peacock Julie Reece Geraldine Stanton Suzanne Tandler Gill Wills Sarah Winfield Staff Nurse, Witley Ward, The Robertson Centre Staff Nurse, Malvern Community Hospital Staff Nurse, Tenbury Hospital District Nurse Team Leader, Droitwich Nurse Advisor for Older People, Crossgates House Community Staff Nurse, Tenbury Community Staff Nurse, Aylmer Lodge Community Staff Nurse, Pershore Medical Centre Name Vicky Preece Carol Clive Stephanie Court Ruth Ward Janet Austin Kerry Beaumont Karen Young Linda Ingles Phil Shakeshaft Ginny Snape Chris Freke Della Lewis Carole Roberson Liz Wadley Committee / group Deputy Director of Nursing Consultant Nurse Infection Control Paediatric Lead Quality Manger Clinical Manager Practice development and Service Lead Mental Health Community Hospital Matron Community Hospital Matron Lead Nurse Community Hospital Matron Clinical Services Operational Lead Clinical Governance Co-ordinator Professional Practice Facilitator for District Nursing Named Nurse - Safeguarding Adults, Integrated Safeguarding Team Accessibility Interpreting and Translation services are provided for Worcestershire Health and Care NHS Trust, including: Face to face interpreting; Instant telephone interpreting; Document translation; and British Sign Language interpreting Please refer to intranet page: for full details of the service, how to book and associated costs. Training and Development Worcestershire Health and Care NHS Trust recognise the importance of ensuring that its workforce has every opportunity to access relevant training. The Trust is committed to the provision of training and development opportunities that are in support of service needs and meet responsibilities for the provision of mandatory and statutory training. All staff employed by the Trust are required to attend the mandatory and statutory training that is relevant to their role and to ensure they meet their own continuous professional development. The Prevention and Management of Skins Tears and Lacerations Page 2 of 20

5 Contents 1. Introduction 4 2. Aim and Purpose of the guideline 4 3. Definition and aetiology of skin tears 4 4. Competencies required 4 5. Patients included 4 6. Assessment and categorisation of skin tears 5 7. Management of skin tears and STAR skin tear box 6 8. Care of the peri wound skin 8 9. When to refer Prevention of skin tears Safeguarding adults Skin protection Monitoring and compliance References Appendix 1 SKIN Tear assessment chart Appendix 2 Patient information leaflet The Prevention and Management of Skins Tears and Lacerations Page 3 of 20

6 1. Introduction Skin tears occur in those individuals with fragile skin, neonates and the elderly. They are the most common wound found amongst the frail elderly and are considered to be largely preventable. The importance of prevention must be considered and the implementation of key principles that can reduce the occurrence of skin tears and maintain skin integrity. This is important as the increase in the population of older people could lead to a rise in the number of skin tears. 2. Aim and purpose of the guideline To ensure the provision of evidenced base care in the prevention and management of skin tears and lacerations 3. Definition and aetiology of skin tears A skin tear is a wound caused by shear, friction, and/or blunt force resulting in separation of skin layers. A skin tear can be partial-thickness (separation of the epidermis from the dermis) or full-thickness (separation of both the epidermis and dermis from underlying structures.) (LeBlanc & Baranoski 2011). 4. Competencies Required The care and management of all patients with skin tears will be performed by a Registered Health Care Professional; the prevention of skin tears should be undertaken by carers, health care assistants and supported by a Registered Health Care Professional. 5. Patients Included Skin tears occur on the extremities including the lower limb, the dorsal aspect of the hands and on the arms (Baranoski 2001 & Baranoski 2003). Whilst skin tears may occur on the front of the leg or on the shin bone these are usually called pre-tibial lacerations and require careful assessment of the blood supply to the lower limb and the consideration of the use of compression as outlined by Beldon (2008). The Prevention and Management of Skins Tears and Lacerations Page 4 of 20

7 6. Assessment and Categorisation of skin tears Specific wound assessment will be needed to establish the type of injury, with a focus on the prevention of further injury (Cooper 2006, Lloyd Jones 2010, Stephen- Haynes & Carville 2011) and to determine the following: location dimensions (length, width depth) percentage of viable/non-viable tissue Degree of flap necrosis. presence of any haematoma type and amount of exudate integrity of surrounding skin Skin tear classification The first classification tool for skin tears was developed by Payne and Martin (Payne & Martin 1990) and updated in 1993 (Payne & Martin 1993) and classifies by the degree of severity of the lesion as Categories I, II, and III: Category 1: Skin tears without loss of tissue. These may be linear-type lesions with separation of the epidermis and dermis or flap-type where an epidermal flap covers the dermis to within 1mm of the wound margin. Category II: The skin tear is subdivided into scant loss of tissue (25% or less) and moderate to large loss of tissue, with more than 25% loss of the epidermal flap Category III: The most severe type of skin tears with the loss of the entire epidermal skin flap. This may be caused by the initial trauma or a necrosing skin flap. Examples of skin tears The Skin Tear Audit and Research (STAR) Classification System (Carville et al 2007) STAR classification system is similar to the Payne Martin (1993) system in comprising three different categories. The development refers to the different levels of epidermal loss and the state of the epidermal tissue. The different level of loss is important and should indicate the care to be provided to preserve the epidermal tissue as much as possible. The state of the epidermal tissue is important as a flap that is pale, dusky or darkened is more likely to break down. The STAR classification The Prevention and Management of Skins Tears and Lacerations Page 5 of 20

8 has gained consensus for implementation in Australia, with evidence of implementation reported within the UK (Stephen-Haynes et al 2011). The STAR acronym may be used as a prompt to ensure the appropriate assessment and prompt treatment of skin tears (Stephen-Haynes & Carville 2011): Select appropriate cleanser to clean the wound Tissue alignment Assess and dress Review and re-assess 7. Management of skin tears and STAR skin tear box The aim of management is to reduce the risk of infection and to close the wound. The focus is on assessment, approximation, application (of dressings) and reassessment. It is important to undertake a holistic, skin and wound assessment. The Worcestershire Health & Care NHS Trust have developed the STAR box to help encourage clinicians to assess and manage skin tears effectively including appropriate dressings, a laminated STAR categorisation chart, guidelines and care pathway. This allows clinicians to implement a care plan for a patient with a newly occurring skin tear in a timely manner by the registered Health care practitioner without the need for referral to tissue viability, Accident and Emergency department or minor injuries unit. The skin tear management flowchart below: 1. Assessment 2. Cleanse the skin 3. Bring edges of the wound together 4. Apply dressing 5. Protect general skin 6. Prevent further skin damage The Prevention and Management of Skins Tears and Lacerations Page 6 of 20

9 1. Clean the wound Use saline or running tap water to remove any dirt or grit and to control bleeding Gently pat dry the surrounding skin 2. Approximate the skin flap If the skin flap is viable, bring the edges together gently easing the flap back into place using tweezers or a gloved finger and use the flap as a dressing. Record any approximation (Cooper 2006). For flaps that are difficult to align, consider using a moistened nonwoven swab, applied for 5-10 minutes to rehydrate the area Consider using wound closure strips to secure large skin flaps. Sutures and staples are not recommended due to the fragility of the skin Apply a skin barrier product as appropriate to protect the surrounding skin. 3. Application of the dressing After securing the flap, select a soft silicone facing dressing and apply without tension. Choose a dressing appropriate for the wound condition and category of skin tear, ensuring a 2cm overlap around the wound. The wear time will be dependent on the type of dressing and amount of exudates. Traditional adhesive strips should be avoided where possible as they may cause traction and further trauma (Meulenieire 2003). Gentle micro-adherent wound closure products may be considered. If possible the dressing should be left in place for up to five days to avoid disturbance of the skin flap. Mark the dressing with an arrow to indicate the direction In which the dressing should be removed 4. Review and reassess At each dressing change (approximately every 3-7 days), gently lift and remove the dressing, working away from the attached skin flap. Silicone-based adhesive removers can be used to avoid trauma to the surrounding skin (Meuleneire, 2003; Beldon, 2006) When removing the dressing, evaluate the wound and take care not to disrupt the skin flap The Prevention and Management of Skins Tears and Lacerations Page 7 of 20

10 Monitor for changes in the wound status and ensure maintenance of skin integrity. Where the skin or flap is pale and dusky/darkened, it is important to reassess within hours as further breakdown may occur Monitor for any signs of infection and manage appropriately according to best practice guidelines( EWMA 2005, EWMA 2006, WUWHS 2008, Wounds UK 2011) Use digital photography where possible to document the wound Treatment can be discontinued if complete epithelialisation occurs 8. Care of the skin and peri-wound skin Protection of the skin is vital in maintaining its integrity. Keep the skin well hydrated by maintaining nutritional intake and fluid balance. Patients with dry skin on their arms and legs will benefit from the application of an appropriate ph friendly moisturising cream twice a day (Hanson et al 2005). It is important to: Avoid the use of soap. Use ph friendly soap and cleansing solutions and apply an emollient. Reduce moisture from incontinence or other sources Use Caution when applying an adhesive tape directly on to the skin Protect fragile skin by covering with tubular or roller bandages, long sleeved clothing etc. 9. When to refer Some complex skin tears or associated full thickness skin injury, significant bleeding or haematoma formation, may require surgical review and intervention to repair the injury. Caution should also be taken where there is concern regarding blood clotting ability and general blood supply. An inter-professional and collaborative approach to management is required to optimise healing outcomes for the individual. The Prevention and Management of Skins Tears and Lacerations Page 8 of 20

11 10. Prevention of skin tears As most skin tears occur during routine patient care activities (Everett and Powell 1994) it is important to consider this and to try and create a safe environment. Identifying and removing factors that cause skin tears can help to reduce prevalence, particularly in the older person. Increasing awareness of risk by patients and carers should also be encouraged. How to create a safe environment Ensure adequate lighting and ease of reaching the light switches Remove rugs and excessive furniture Ensure any small furniture (night table, chairs) in the immediate surroundings are positioned carefully to avoid unnecessary bumps or knocks to the patient. Upholster sharp borders of furniture or bed surroundings with padding and soft material Use appropriate aids when transferring patients and employ good manual handling techniques according to local manual handling guidance e.g. lifting device, slide sheets. Bed sheets should NEVER be used to move the patient as this can contribute to damage by causing a dragging effect on the skin (Beldon, 2006). Where possible reduce or eliminate pressure, shear and friction using pressure relieving devices and positioning techniques Encourage the wearing of appropriate footwear and clothing to reduce the risk of injury. Long Socks may be worn to protect the pre tibial area Ensure that adhesive dressings are avoided where there is a risk of a skin tear. Ensure that adhesive dressings are removed slowly to avoid the risk of skin tears. 11. Safeguarding Adults Where a skin tear resulting in harm to a patient is considered or expected to be caused due to neglect and/or acts of omission, or physical abuse, a safeguarding adult referral should be made using the Trust Safeguarding Adult Pathway (Safeguarding Adults Policy WHCT 2012). The Prevention and Management of Skins Tears and Lacerations Page 9 of 20

12 Self-Neglect. Consideration should be made to the Trust Guidance for the Management of Self-Neglect in Adults, where skin tears are considered to be a factor in patients who are self-neglecting. (Guidance for the Management of Self- Neglect in Adults 2013 ( Skin protection An essential aspect of skin protection is keeping the skin well hydrated by maintaining nutritional intake and fluid balance. Cleansing moisturising and protection of the skin is vital in maintaining skin integrity. Patients with dry skin on their arms and legs will benefit from the application of an appropriate ph friendly moisturising cream twice a day (Hanson et al 2005). It is important to: Avoid the use of drying soaps. Use ph friendly soap and cleansing solutions Apply creams or lotions to maintain the suppleness of the skin Reduce moisture from incontinence or other sources Place, fix and remove peripheral access devices carefully using a silicone based tape Caution should be taken when applying an adhesive tape directly on to the skin Protect fragile skin by covering with tubular or roller bandages, long sleeved clothing etc. 13. Monitoring and compliance Monitoring Tool STANDARDS % Clinical Exceptions All patients will be given timely treatment to maximise salvage of the skin tear. All patients will have completed STAR skin tear assessment forms 100 Nil 100 Nil All patients will have their skin tear categorised 100 Nil Wound management will be based upon the assessment and categorisation of the skin tear Preventative strategies will be implemented to prevent further skin tears 100 Nil 100 Nil The Prevention and Management of Skins Tears and Lacerations Page 10 of 20

13 14. References Baranoski, S. (2001) Skin tears: Guard against this enemy of frail skin. Nurs Management 32: Baranoski, S. (2003) How to prevent and manage skin tears. Adv skin wound care 16(5) : Beldon, P. (2008) Classifying and managing pretibial lacerations in older people. British Journal of Nursing, Tissue Viability Supp, 17: 11, S4 -S18 Butcher, M. White, R. (2005).The structure and function of the skin. In: White R (ed) Skin Care in Wound Management: Assessment and Treatment. Wounds UK, Aberdeen Carville, K. Lewin, G. Newall, N. Haslehurst, P. Michael, R. Sanatamaria, N & Roberts, P. (2007) STAR: A consensus for skin tear classification. Primary Intention 15: Cooper, P. (2006) Managing the treatment of an older patient who has a skin tear. Wound Essential 1: Desai, H. (1997) Ageing and wounds part 2: healing in old age. Journal of wound care 6(5) p European Wound Management Association (2005) (EWMA). Position Document: Identifying criteria for wound infection. London: MEP Ltd. European Wound Management Association (2006) (EWMA). Position Document: The management of infection. London: MEP Ltd. Everett S & Powell T. (1994) Skin tears - The underestimated wound. Primary Intention 2:8-30. Guidance for the Management of Self-Neglect in Adults (2013) Hanson DH, Anderson J, Thompson P, Langemo D. (2005) Skin tears in long-term care: effectiveness on skin care protocols on prevalence. Advanced Skin Wound Care; 18:74. LeBlanc, K. Baranoski, S. (2011) Skin Tears: State of the Science: Consensus Statements for the Prevention, Prediction, Assessment, and Treatment of Skin Tears. Adv Skin Wound Care; 24(9):2-15 Lloyd Jones, M. (2010) Best Practice Statement. The assessment and management of skin tears. All Wales Tissue Viability Nurse Forum. MA healthcare. Dulwich. UK Meuleneire, F. (2003) The Management of skin tears. Nursing Time Suppl. Wound care 99(5) Morey (2007) Skin Tears: A literature review. Primary Intention 15:3, Mudge, E. & Orsted, H. Wound infection and pain management made easy. Wounds International. =1 The Prevention and Management of Skins Tears and Lacerations Page 11 of 20

14 Payne, R. Martin, M. (1990) Skin Tears The epidemiology and management of skin tears in older adults. Ostomy Wound management. 26: Payne,R.. Martin, M. (1993) Defining and classifying skin tears: need for a common language. A critique and revision of the Payne-martin classification system for skin tears. Ostomy Wound management. 39 (5): Resnick, B. Wound care for the elderly. Geriatr Nurs. 1993; 14(1): Sibbald, R. Krasner, D., Lutz, J. et al. ( 2009) The SCALE Expert Panel: Skin Changes At Life s End. Final Consensus Document. October 1. Safeguarding Adults Policy WHCT (2012) Stephen-Haynes, J. Callaghan, R. Bethall, E & Greenwood, M. (2011) The assessment and management of skin tears in care homes. British Journal of Nursing. Vol 20 No11 S Stephen-Haynes, J. & Carville. ( 2011) Skin Tears made Easy. Wounds International 2(4) November. Voegell, D. (2010) Basic essentials. Why elderly skin requires special treatment. Nursing & Residential Care. Vol 12 No White, M. Karam, S. Cowell, B. (1994) Skin tears in frail elders. A practical approach to prevention. Geriatr Nur ;15(2):95. World Union of Wound Healing Societies (2004) (WUWHS). Principles of best practice: Minimising pain at wound dressing-related procedures. A consensus document. London: MEP Ltd. WUWHS ( 2008) Wound infection in clinical practice. A consensus document. Principles of best practice. London : MEP Ltd, Wounds UK Best Practice Statement ( 2011) The use of topical antiseptic/antimicrobial agents in wound management. Wounds UK. Available from: The Prevention and Management of Skins Tears and Lacerations Page 12 of 20

15 SKIN TEAR AND LACERATION ASSESSMENT & TREATMENT CHART PATIENTS NAME: PATIENT NHS: PATIENT DOB Date Skin Tear developed Previous skin tear(s) Yes No Cause of skin tear: Fall Trauma impaired mobility impaired vision Manual handling Poor nutrition/hydration Cognitive or sensory impairment Dry/ fragile skin Medication Vascular status Action taken to reduce the risk of further skin tear(s) General Assessment Waterlow Score: Urinalysis: Hb: BM: INR Platelets: FBC/Serum Protein: Other: Factors which may affect wound healing (Please circle all that apply) Diabetes Anaemia Infection Poor Nutritional status Under/Over weight Immobility Smoking Jaundice Non-concordance Medication e.g. steroids Other (specify) Allergies: Clinician Name: Signature: Date: The Prevention and Management of Skins Tears and LacerationsPage 13 of 20

16 Location of Skin Tear/ Laceration Mark location of skin tear/s on body map using an X Date Photograph & date taken Consent (Y/N) Healed (date) Skin Tear Laceration The Prevention and Management of Skins Tears and LacerationsPage 14 of 20

17 Patient Name Patient No. Wound No: Evaluation Evaluation Evaluation Evaluation Wound Dimensions (cm) Length Width Depth Underminning Tracing / photo no Tissue - Wound Appearance (Colour copy in Wound Management Formulary). Specify % 1. Epithelialisation (Pink) T 2. Granulating (Red) 3. Sloughy (Yellow) 4. Infected (Green) 5. Necrotic (Black) 6. Over granulation (Raised pink/red) 7. Unhealthy granulation (Dull) Infection 1. Colonised 2. Critically Colonised I 3. Local Infection 4. Systemic Infection Swab sent Organism isolated Anti-microbial therapy Managing Exudate 1. Colour 2. Amount (specify dressing wear time) M 3. Type 4. Odour Skin type 1. Dry 2. Paper thin 3. Translucent E 4. Bruised 5. Ageing/Purpura 6. Healthy Pain Assessment (Wound Related) Yes specific pain assessment chart No Nurses Signature Nurses Signature Nurses Signature Nurses Signature Date Date Date Date The Prevention and Management of Skins Tears and LacerationsPage 15 of 20

18 Wound No: TREATMENT OBJECTIVE 1. Re-approximate skin tear 2. Promote Epithelialisation 3. Promote Wound Granulation 4. Remove Slough/debridement 5. Manage Infection/Odour 6. Promote Wound Maturation 7. Manage exudate 8. Manage pain 9. Palliative Care Evaluation: Date Date Date Date Objective: (insert number(s) from list above) Wound Cleansing Method if appropriate: Dressing Applied: Size of dressing: Instructions for application/ removal of the dressing: Emollients, Skin Care: Comments: (i.e. specific patient advise, allergies to dressings) Print Name: Signature: The Prevention and Management of Skins Tears and LacerationsPage 16 of 20

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21 Equality Analysis Title of Policy/Function (Function Includes: Services; Projects; Strategy; Processes; Systems; Practices; Procedures; Protocols; Guidelines; Care Pathways etc..) Guideline for Skin Tear prevention and management New New Existing/Revised Short description of Policy/Function (aims and objectives, is the policy/function aimed at a particular group if so what is the intended benefit): This document has been produced to support Registered Healthcare Professionals working within Worcestershire Health & Care NHS Trust; it should be referred to for the recommended best practice for managing a patient with a skin tear. The guideline will reduce potential risk and harm to patients with a skin tear and laceration. The role of the Registered Health Care Professional will be defined in this guideline, outlining their responsibility and accountability for the patient with a skin tear. Name of Job Title Contact details Lead/Author(s) Professor Jackie Stephen- Consultant Tissue Viability Nurse j.stephen-haynes@nhs.net Haynes Rosie Callaghan Tissue Viability Specialist Nurse r.callaghan@nhs.net Claire Bolton Tissue Viability Specialist Nurse claire.bolton@hacw.nhs.uk When the policy/function involves patients/staff/partners/stakeholders etc. please where possible include them in the Equality Analysis to demonstrate openness, transparency and inclusion and particularly by those who this policy/function is most likely to have impact. Does this Policy/Function have any potential or actual impact that is positive(+), neutral (N) or negative (-) impact on the following protected characteristics please indicate: + N - Please provide a rational/justification for each of the following regardless of impact Age N This policy applies to everyone irrespective of age Disability N This policy is not relevant to disability Gender Reassignment N The policy would be applied to an individual who is undertaking gender reassignment as it would to any other person. Pregnancy & Maternity N This policy is not relevant to pregnancy & maternity. Race N The policy is applicable to everyone regardless of race Religion & Belief N This policy is not relevant to religion & belief. The policy does not have a negative or positive impact with regard to a person s religion or belief Sex N This policy applies to both men and women in the same way. Sexual orientation N Skin Tear prevention and management would be applied in the same way to everyone irrespective of their sexual orientation Marriage & Civil Partnership N The Skin Tear prevention and management policy is applicable to everyone irrespective of their marital or civil partnership status. The Prevention and Management of Skins Tears and Lacerations Page 19 of 20

22 Other Groups who could experience inequality, e.g. carers, homeless, travelling communities, unemployed, people resident within deprived areas, different socio/economic groups e.g. low income families, asylum seekers/refugees, prisoners, people confined to closed institutions or community offenders, people with different work patterns e.g. part-time, full-time, job-share, short-term contractors or shift workers - Access, location and choice of venue, timings of events and activities. Support with caring responsibilities Analysis conducted by: (minimum of 3 people) Name Job Title Contact details 1 Jackie Stephen-Haynes Professor & Consultant j.stephen-haynes@nhs.net nurse in Tissue Viability 2 Rosie Callaghan Tissue Viability Nurse rosiecallaghan@nhs.net Specialist 3 Michelle Greenwood Tissue viability Nurse Start date of policy/function April 2014 Period valid for : 24 months Review date of policy/function April 2016 Service Delivery Unit: Reference/Version: Date Equality Analysis completed: D D M M Y Y If you have identified a potential discriminatory impact on the policy/function please refer it to the author together with suggestions to avoid or reduce the impact. A copy of the completed Equality Analysis must be attached to the policy/function and a copy sent to: Patrick McCloskey Equality Inclusion Practitioner Isaac Maddox House, Shrub Hill Road, Worcester, WR4 9RW Tel: Patrick.mccloskey@hacw.nhs.uk The Prevention and Management of Skins Tears and Lacerations Page 20 of 20