Guideline Title: Ref No: 1820 Version: 2 Document Author: Tissue Viability Nurse Date 15/02/2017 Ratified by: Care and Clinical Policies Group Date: 15/02/2017 Review date: 10 March 2019 Links to policies: This referral pathway is designed for use by all teams and Community Hospitals within the South Devon and Torbay CCG foot print, including Torbay Hospital. Referrals to the TV Service are acknowledged Monday to Friday 9am 5 pm from all allied Healthcare professionals, General Practitioners, Consultants, Nursing Home Staff, Acute Hospital Trusts and self-referrals. Messages can be left on the relevant TV answerphone (Acute or Community) with return calls being undertaken on the next working day. Referral from patients and carers will be accepted as long as basic first assessments have been undertaken by health care professionals. All referrals received by the TV Service, whether in the Acute or Community setting, will be prioritized according to the information provided by the referrer. All Community Service Delivery Unit (CSDU) referrals must be completed via the referral form (see appendix 1) and emailed, with a good quality photograph, To: t-sd.tissueviability@nhs.net/ 01626895236. Referrals from the Acute Service Delivery Unit (ASDU) can be telephoned directly to the Acute TV Team on: 01803 655 814 The Response time for all referrals will depend on the severity, and complexity, of the patient s condition and the wound, following triage by the TV Team, with a Level of urgency being identified (see below). The referrer will be informed of the prioritization the referral has been given by the TV team. Version 2 (March 2017) Page 1 of 3
Level 1 Urgent Referrals for patients with very complex conditions complex wounds or life threatening wounds: Patient s with suspected or confirmed Necrotizing Fasciitis. Patient s with Grade/Category 4 (EPUAP) pressure ulcers. Patient s with unexplained rapid deterioration in any wound. Patient s with dehisced abdominal wounds with exposed bowel, complex bowel sinuses and fistulas. Patients who require advice about management of pressure ulcers or complex wounds at the end of life Level 2 Non urgent referrals for patients with less complex wounds and conditions Patient s with non-complex Topical Negative Pressure (TNP) therapy who require advice on on-going management. Patients with Grade/Category 3 (EPUAP) pressure ulcers. Patients with chronic wounds that have failed to respond to conventional treatment as expected over a given time period e.g. a venous leg ulcer. Patients with surgical wounds that have failed to heal e.g. a perianal abscess. Patients who require highly specialized pressure ulcer prevention equipment. Level 3- Non urgent referrals for patients with chronic longstanding wounds Patients with long standing chronic leg ulcers where there is no surgical intervention available due to arterial disease, chronic lymphovenous disease, un-resolving obesity or refusal to accept current best practice recommendations. Patients with long standing leg ulceration due to venous disease who have failed to respond to standard compression therapy. Patients with other chronic wounds that have been clinically assessed and are judged unlikely to heal due to co-morbidities. Version 2 (March 2017) Page 2 of 3
Exclusion criteria Referrals for the following will not be considered appropriate: Patient s with skin conditions but no open wounds: referral should be made to Dermatology. Diabetic foot ulcers: referrals should be made to diabetic podiatry service. Patient s whose condition is being managed by the Vascular Service. Patients with wounds that are healing as expected. Patients that have had no prior wound assessment by the referring clinician. Patients with cellulitis but without active ulceration. Patients previously seen by the TV team who have no new identified wound related complications. Non concordant patients who have been advised by the TV service on previous occasions and have refused all treatment options offered and have indicated they do not wish to take future advice from the tissue viability service. The TV team does not provide a compression bandaging or dressing service. Version 2 (March 2017) Page 3 of 3
Community referral process Acute referral process Appendix 1 Clinical staff identify a patient requiring a referral to the TV service, following review of the referral criteria. Consider whether referral to GP alternative agencies/specialist or member of staff who has received extended TV training may be more appropriate. Clinical staff identify a patient requiring a referral to the TV service, following review of the referral criteria. Consider whether referral to Consultant alternative agencies/specialist or member of staff who has received extended TV training may be more appropriate. Clinical staff to ensure a recent reassessment of the patient, and the wound, has been undertaken by an appropriately trained practitioner and recorded in the patient s care notes. Clinical staff to ensure a recent reassessment of the patient, and the wound, has been undertaken by an appropriately trained practitioner and recorded in the patient s care notes. A TV referral form (appendix 1) and good quality photograph must be completed and emailed or posted to the TV office. For urgent referral please contact the Community TV office directly on 01626895236 Email: t-sd.tissueviability@nhs.net Post: Community Tissue Viability Team Dawlish Community Hospital Barton Terrace, Dawlish, EX7 9QH Contact the Acute TV team on 01803655814. We will require the following information: Patient name Patient NHS number Patient D.O.B Patient past medical history Patient location Description of the wound If the referral is urgent [in line with criteria] the TV service will contact the referrer or team within 1 working day to give urgent advice or arrange a joint visit or hospital appointment if appropriate. For non-urgent referrals the TV service will contact the referrer or team within 2 working days If the referral is urgent [in line with criteria] the TV service will contact the referrer or team within 1 working day to give urgent advice or arrange a joint visit if appropriate. For non-urgent referrals the TV service will contact the referrer or team within 2 working days Appendix 1 Referral Process Version 2 (March 2017) Page 1 of 3
COMMUNITY TISSUE VIABILITY(TV) SERVICE REFERRAL FORM A TV referral form and good quality photograph must be completed and emailed or posted to the Community TV office, see bottom of form for address information. Patient Details Name Date of Birth NHS Number Phone No Home address Location (if different from home address) Referrers Details Name Phone no Address Date Referral Sent GP Details Name Phone no Address Past Medical History Type of Wound (please all wound types) Pressure Ulcer (EPUAP) Grade 3 Pressure Ulcer (EPUAP) Grade 4 Sinus or Fistula Leg Ulcer Surgical Wound Malignancy Other Wound type (please specify) Traumatic Wound Diabetic Foot Ulcer Current dressing regime Reason for referral Does the patient fit the criteria for urgent referral? (criteria available via icare) Yes / No (please delete as appropriate) Has the patient been seen by the Acute TV service in the last 12 months? Yes / No / Unsure appropriate) (please delete as Has the patient had a full leg ulcer assessment? Yes / No / Unsure (please delete as appropriate) Wound Date: If not, please give reasons: Appendix 1 Referral Process Version 2 (March 2017) Page 2 of 3
ABPI Right Leg: Signals Right Leg: ABPI Left Leg: Signals Left Leg: Wound 1 Location Length: Width: Depth: Wound 2 Location Length: Width: Depth: Wound 3 Location Length: Width: Depth: Wound 4 Location Length: Width: Depth: Tissue Type (please all that apply; also add any other relevant information): Necrotic: Slough Granulating: Epithelializing: Infection: Recent Swab Result: Medication & Equipment: Allergies: PT Weight: Equipment Mattress: Equipment Seating: Equipment Other: Other relevant information / factors affecting the patient e.g. patient concordance, pain care package: Must Score: Other healthcare professionals / agencies involved Describe current ability to mobilise / move: Comments: Other Please send this referral to the Community TV Service. Waterlow score: Community: t-sd.tissueviability@nhs.net Tel: 01626 895236 Tissue Viability, Dawlish Hospital, Barton Terrace, Dawlish, EX7 9DH Appendix 1 Referral Process Version 2 (March 2017) Page 3 of 3
Amendment History Issue Status Date Reason for Change Authorised 1 Ratified November 2013 New 2 Ratified 10 March 2017 Revised Care and Clinical Policies Group Document Control Information Version 2 (March 2017) Page 1 of 1
The Mental Capacity Act 2005 The Mental Capacity Act provides a statutory framework for people who lack capacity to make decisions for themselves, or who have capacity and want to make preparations for a time when they lack capacity in the future. It sets out who can take decisions, in which situations, and how they should go about this. It covers a wide range of decision making from health and welfare decisions to finance and property decisions Enshrined in the Mental Capacity Act is the principle that people must be assumed to have capacity unless it is established that they do not. This is an important aspect of law that all health and social care practitioners must implement when proposing to undertake any act in connection with care and treatment that requires consent. In circumstances where there is an element of doubt about a person s ability to make a decision due to an impairment of or disturbance in the functioning of the mind or brain the practitioner must implement the Mental Capacity Act. The legal framework provided by the Mental Capacity Act 2005 is supported by a Code of Practice, which provides guidance and information about how the Act works in practice. The Code of Practice has statutory force which means that health and social care practitioners have a legal duty to have regard to it when working with or caring for adults who may lack capacity to make decisions for themselves. The Act is intended to assist and support people who may lack capacity and to discourage anyone who is involved in caring for someone who lacks capacity from being overly restrictive or controlling. It aims to balance an individual s right to make decisions for themselves with their right to be protected from harm if they lack the capacity to make decisions to protect themselves. (3) All Trust workers can access the Code of Practice, Mental Capacity Act 2005 Policy, Mental Capacity Act 2005 Practice Guidance, information booklets and all assessment, checklists and Independent Mental Capacity Advocate referral forms on icare http://icare/operations/mental_capacity_act/pages/default.aspx Infection Control All staff will have access to Infection Control Policies and comply with the standards within them in the work place. All staff will attend Infection Control Training annually as part of their mandatory training programme. The Mental Capacity Act Version 2 (March 2017) Page 1 of 1
Rapid (E)quality Impact Assessment (EqIA) (for use when writing policies) Policy Title (and number) Policy Author Version and Date An (e)quality impact assessment is a process designed to ensure that policies do not discriminate or disadvantage people whilst advancing equality. Consider the nature and extent of the impact, not the number of people affected. Who may be affected by this document? Patients/ Service Users Staff Other, please state Could the policy treat people from protected groups less favorably than the general population? PLEASE NOTE: Any Yes answers may trigger a full EIA and must be referred to the equality leads below Age Yes No Gender Reassignment Yes No Sexual Orientation Yes No Race Yes No Disability Yes No Religion/Belief (non) Yes No Gender Yes No Pregnancy/Maternity Yes No Marriage/ Civil Partnership Yes No Is it likely that the policy could affect particular Inclusion Health groups less favorably than Yes No the general population? (substance misuse; teenage mums; carers 1 ; travellers 2 ; homeless 3 ; convictions; social isolation 4 ; refugees) Please provide details for each protected group where you have indicated Yes. VISION AND VALUES: Policies must aim to remove unintentional barriers and promote inclusion Is inclusive language 5 used throughout? Yes No NA Are the services outlined in the policy fully accessible 6? Yes No NA Does the policy encourage individualised and person-centered care? Yes No NA Could there be an adverse impact on an individual s independence or autonomy 7? Yes No NA EXTERNAL FACTORS Is the policy a result of national legislation which cannot be modified in any way? Yes No What is the reason for writing this policy? (Is it a result in a change of legislation/ national research?) Who was consulted when drafting this policy? Patients/ Service Users Trade Unions Protected Groups (including Trust Equality Groups) Staff General Public Other, please state What were the recommendations/suggestions? Does this document require a service redesign or substantial amendments to an existing Yes No process? PLEASE NOTE: Yes may trigger a full EIA, please refer to the equality leads below ACTION PLAN: Please list all actions identified to address any impacts Action Person responsible Completion date AUTHORISATION: By signing below, I confirm that the named person responsible above is aware of the actions assigned to them Name of person completing the form Signature Validated by (line manager) Signature Please contact the Equalities team for guidance: For South Devon & Torbay CCG, please call 01803 652476 or email marisa.cockfield@nhs.net For Torbay and South Devon NHS Trusts, please call 01803 656676 or email pfd.sdhct@nhs.net This form should be published with the policy and a signed copy sent to your relevant organisation. Rapid Equality Impact Assessment Version 2 (March 2017) Page 1 of 1