Skin Integrity Service provide innovative solutions to continue supporting patients with wounds during pandemic

The Skin Integrity Service (sometimes referred to as the Tissue Viability Team) provides specialist clinical advice, education and support to all individuals relating to wounds and wound care. This includes people who are receiving care from GP’s, District Nurses, Practice Nurses and Nurses employed in the private sector.

The team works closely with other health care professionals, family members and carers to agree a care plan that is achievable and practical to encourage the best outcomes.

However, with disruption to health and care services across the county as a result of the coronavirus pandemic, members of local communities were left vulnerable should they have required urgent or ongoing support relating to wounds.

Sarah Bagley, Care Plus Group’s Tissue Viability Nurse, said: “One of our main concerns was around community nurses reducing their contact with care homes due to shutting their doors, in order to reduce the number of professionals thereby protecting their residents. In turn there was unease that some of the residents might not have received the care they would have ordinarily expected.”

To help alleviate these concerns the Skin Integrity Service came up with an initiative to provide care homes with resources to enable them to administer and manage injuries such as wounds themselves on site.

Sarah said: “As a team we had the idea to put some boxes together which included basic wound care resources such as dressings, pads, gauze and cleansing solution. We managed to procure the resources and assemble the boxes really quickly. We had them all ready to roll out by the end of March, enabling us to hand deliver the boxes to 48 care homes in total, in the first few weeks of lockdown.”

Aside from supplying the care homes with basic wound resources the Skin Integrity Service also shared information and provided subsequent training to staff at care homes on how to use the equipment to manage wound care themselves, correctly and confidently.

Sarah said: “A lot of the initial training was held outside in the foyer or grounds of the care homes, as at that point it was difficult to get inside the building. We showed staff how to use the boxes, what we wanted the boxes to be used for and passed on our contact details should anyone need to get in touch with us.

“The concept of the resource boxes came about as we contemplated if a resident was to get a traumatic would, for example a common skin tear. Normally care home staff would call the Community Urgent Care Team (CUCT) or the community nurses, but obviously that might not have been able to happen at that point. Therefore, we wanted the care homes to have the confidence to provide basic wound care to make the wounds safe, to reduce the risk of infection and stop the bleeding.

“We didn’t want the care homes to completely take over the care of these wounds as the carers are not nurses and there is a need for ongoing management of those type of wounds, but what we wanted was for them to have a few days grace before a qualified nurse came in to look after the wound. The resource boxes and training went really well and were very well received by care homes in the area.”

Due to the success of the initiative from the Skin Integrity Service, the North East Lincolnshire Clinical Commissioning Group subsequently sent information that Care Plus Group had developed this novel approach to NHS England. This innovative initiative was then escalated to ambulance services nationally where it is being piloted.

Sarah said: “In some areas of the country where they don’t have as good urgent care as we have, often ambulances are called to treat residents with skin tears. However, as there are normally no resources to treat wounds at care home, those residents are then admitted to A&E for something that really ought to have been managed on site.

“The initiative is now being piloted by ambulance services in other parts of the country, and as far as we know it’s going very well and we’re having ongoing communication about the project with NHS England.”

Another important part of the Skin Integrity Team’s role is to provide education to health care professionals in relation to all aspects of wound management and prevention in order to ensure that the best care is provided to the local population.

Whilst the Skin Integrity Service normally deliver up to 20 face-to-face sessions of prevention and management of pressure damage training to care homes this wasn’t going to be possible due to the national lockdown and with social distancing measures. Consequently, the team developed a remote e-learning training package on wound management with an associated quiz to help plug the gap.

Sarah added: “We wanted to make sure standards didn’t slip whilst we were unable to deliver our routine training sessions. Therefore we decided to record our “traffic light” presentation and develop a quiz alongside it to measure the competence and understanding of care home staff.

“We’d sent the training resources to all our care homes and once they’d completed the training we asked them to send their quizzes back to us for marking. This way we can still measure their competency whilst also updating their compliance metrics, giving us an indication if the care homes were still accessing our training.

“We know they’re doing it as we’ve had a lot of quizzes to mark, so that’s taken a lot of our time but it seems to have worked really well.”

Aside from training care home staff around the county, the team from the Skin Integrity Service also put in a lot of time helping to train up new staff who had just started at Care Plus Groups new rehabilitation and reablement unit Cambridge Park.

Sarah said: “We’ve carried out a lot of training at Cambridge Park taking our new starters through all the mandatory training at the facility – using social distancing measures – to get everyone up to speed. We’ve also been working closely with the Lead Nurse at Cambridge Park, who’ll contact us if she has any concerns about residents, just so that nothing is ever missed and people are getting the correct treatment when required.”

At the start of the pandemic there were grave concerns from the team and Acute Trusts regarding the usage of personal protective equipment (PPE) and how this was translating to staff getting pressure or moisture damage on the bridge of their nose and around their face from wearing masks and visors.

Sarah added: “The team created a video explaining how members of staff in care settings could protect their skin whilst wearing PPE for long periods of time. We were particularly concerned about the carers in care homes as they need to wear face masks for longer periods and we had a lot of staff members contact us from those settings with their worries.

“We’ve been working with and supporting them as much as possible and sent out our training video depicting how carers and staff can protect their skin. We’ve had great feedback on this resource and it’s proven to be a valuable asset in these times of need.”

The Skin Integrity Team are also in the process of developing an app which will be downloaded onto staffs work mobile phones. The app will give staff access to policies and guidelines relating to skin integrity and will also provide valuable tools and resources for staff to use in practice. This will enable instant access to these resources at the point of contact with the patient which should help to improve patient care. The app is still in progress but the Skin Integrity Team are hoping to launch it soon.

Sarah concluded: “It’s been a very busy period for the Skin Integrity Service since the start of the pandemic, but we’re so pleased our colleagues and members of the community have found our resources and support useful, helping to encourage the best outcomes for patients and residents.”

The guidance for the prevention and management of skin damage beneath PPE video produced by the Skin Integrity team can be found on the Care Plus Group website here www.careplusgroup.org/ppeskinintegrity.

The Traffic Light Prevention and Management of Pressure Damage video and associated quiz can be found on the website here https://careplusgroup.org/traffic-light-training.

For further information or to contact Care Plus Group’s Skin Integrity Service please call 01472 256765 or email CPG.SkinIntegrityTeam@nhs.net.