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Registration Number: {{org_field_registration_no}}

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Wound Care and Management Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} provides safe, effective, and evidence-based wound care to individuals receiving domiciliary care. Proper wound management is essential in preventing infections, promoting healing, and improving overall health outcomes. This policy outlines best practices, staff responsibilities, and the procedures for identifying, assessing, treating, and monitoring wounds.

This policy must be read and implemented in accordance with:

• the Regulation and Inspection of Social Care (Wales) Act 2016;
• the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended, particularly regulations 6, 12, 15 to 18, 21, 25, 26, 27, 34, 36, 55, 56, 57, 59 and 60;
• the statutory guidance for service providers and responsible individuals issued under section 29 of the Regulation and Inspection of Social Care (Wales) Act 2016;
• the Social Services and Well-being (Wales) Act 2014 and the Wales Safeguarding Procedures where a wound, pressure damage or failure to obtain treatment raises a concern of abuse, neglect or improper treatment;
• the Mental Capacity Act 2005 and its Code of Practice where an individual may lack capacity to consent to wound care;
• the UK General Data Protection Regulation and the Data Protection Act 2018 in relation to wound records and photographs;
• the Health and Safety at Work etc. Act 1974, the Control of Substances Hazardous to Health Regulations 2002 and applicable healthcare-waste and sharps requirements; and
• current Welsh Government, Public Health Wales and NICE guidance relevant to skin integrity, pressure damage, wound management and infection prevention and control.

2. Scope

This policy applies to:

• All employees of {{org_field_name}}, including care staff, managers, and supervisors.
• All individuals receiving wound care and management services, including those with pressure ulcers, surgical wounds, chronic wounds, and minor injuries.
• Healthcare professionals, district nurses, and GPs, where collaboration is required.

This policy distinguishes between:

• routine observation of the individual’s skin by care staff;
• assistance with wound care that the individual is able to direct and manage themselves;
• a healthcare activity formally delegated to a named care worker by an appropriate registered healthcare professional; and
• clinical assessment, diagnosis, prescribing and treatment planning, which remain the responsibility of an appropriately qualified healthcare professional.

Care workers must not independently diagnose, classify, stage, probe, measure the depth of, prescribe treatment for, select clinical products for, debride or otherwise clinically treat a wound unless the specific activity has been lawfully delegated, the worker has been assessed as competent and the activity is permitted by the service’s statement of purpose, insurance and governance arrangements.

This policy covers:

• Wound assessment and classification.
• Procedures for wound care and dressing changes.
• Infection prevention and control measures.
• Record-keeping and reporting requirements.
• Staff training and competency in wound management.

3. Policy Statement

{{org_field_name}} is committed to providing high-quality wound assessment, treatment, and management using a person-centred approach. Our goal is to:

• Prevent and minimise wound complications.
• Promote healing through evidence-based practices.
• Ensure wound care is delivered safely, competently, and in compliance with professional guidelines.
• Support collaboration with healthcare professionals to optimise care.

4. Managing Wound Care Efficiently

4.1 Identification, Observation and Clinical Assessment of Wounds

Care staff must observe the individual’s skin only to the extent required by the individual’s personal plan, risk assessment and their role. Any new wound, skin break, blister, non-blanching redness, discolouration, swelling, heat, discharge, odour, bleeding, pain, deterioration or concern must be reported promptly to the person in charge and referred to the appropriate healthcare professional.

A clinical wound assessment, diagnosis, classification, pressure-ulcer categorisation, treatment decision or alteration to a wound-care plan must be undertaken by an appropriately qualified and competent healthcare professional, or by a worker carrying out a clearly specified delegated activity within the limits of that delegation.

Where a skin-integrity or pressure-damage assessment is required:

• an assessment tool approved for use in Wales must be used;
• the person undertaking the assessment must have the required knowledge, skills and competence;
• individuals identified as being at risk must be supported in accordance with the applicable Public Health Wales SKIN bundle or its current replacement;
• appropriate pressure-relieving equipment and repositioning instructions must be documented in the personal plan and followed; and
• specialist advice must be obtained where required.

The individual’s personal plan and risk assessment must identify:

• the wound or skin-integrity concern;
• who is clinically responsible for assessment and treatment;
• the precise activities that care staff may and may not undertake;
• the prescribed or agreed dressing and products;
• the frequency and timing of care;
• pressure relief, repositioning, nutrition, hydration and continence measures where relevant;
• pain indicators and agreed pain-management arrangements;
• signs of deterioration requiring escalation;
• the healthcare professional and service to be contacted; and
• any contingency arrangements where the planned care cannot be completed.

The personal plan and risk assessment must be reviewed whenever the wound changes, professional advice changes, the individual’s condition deteriorates, the planned intervention is ineffective or a staff member reports that the plan cannot be followed safely.

4.2 Delegated Wound-Care Activities

Wound care undertaken by a care worker as a delegated healthcare activity must be supported by a documented, individual-specific delegation from an appropriate registered healthcare professional.

Before the activity is undertaken, the provider must ensure that:

• the delegating professional has assessed the individual and determined that the activity is suitable for delegation;
• the activity is within the service’s statement of purpose and the worker’s role;
• the written delegation identifies the individual, activity, wound site, procedure, products, frequency, expected outcome, limits of the delegation, escalation criteria and review date;
• the named worker has received individual-specific instruction and supervised practice;
• the delegating professional or another appropriately qualified assessor has confirmed and recorded the worker’s competence;
• the worker understands that they may decline or stop the activity if they do not feel competent, the circumstances have changed or the activity cannot be completed safely;
• arrangements are in place for supervision, review, reassessment and withdrawal of the delegation; and
• a contingency plan identifies what staff must do if the worker is unavailable, supplies are missing, the dressing cannot be completed or the wound has changed.

Delegation is individual-specific and task-specific. Competence for one individual or procedure must not be treated as authority to undertake wound care for another individual or to undertake a different procedure.

A care worker must not alter the treatment plan, substitute a dressing or topical preparation, increase or reduce treatment frequency, recommence discontinued treatment or continue a delegated activity beyond its review date without instructions from the responsible healthcare professional.

The registered healthcare professional retains accountability for the decision to delegate. The care worker remains accountable for performing the activity safely, within their competence, in accordance with the delegation and for reporting any concern or change without delay.

4.3 Wound Care and Dressing Changes

A dressing change may only be undertaken where it is included in the individual’s current personal plan and written wound-care instructions and, where applicable, has been formally delegated to a named worker who has been assessed as competent.

Staff must use the technique specified by the responsible healthcare professional. This may include an aseptic non-touch technique or another specified clean or aseptic technique. Staff must not assume that the same technique is appropriate for every wound.

The procedure must include:

1. checking the individual’s identity, current personal plan, wound-care instructions, delegation record and any known allergies or sensitivities;
2. explaining the procedure and obtaining valid consent before beginning;
3. checking that the environment permits the procedure to be completed safely and with the individual’s privacy and dignity protected;
4. checking that all required dressings, cleansing products, personal protective equipment and waste containers are available, in date, intact and prescribed or specified for that individual;
5. performing hand hygiene and applying personal protective equipment appropriate to the assessed risk;
6. removing the existing dressing without touching key parts and observing, without probing or manipulating the wound, for changes specified in the escalation plan;
7. stopping the procedure and seeking advice where the dressing is adherent and cannot be removed safely, there is unexpected bleeding, significant pain, wound breakdown, exposed tissue or another unexpected finding;
8. cleansing the wound only with the solution and method specified in the current wound-care plan;
9. applying only the dressing, topical preparation or treatment specified in the current wound-care plan;
10. disposing of clinical waste and sharps in accordance with the service’s infection prevention and control and waste procedures;
11. removing personal protective equipment and performing hand hygiene; and
12. completing the required records and reporting any concern or variance from the plan.

Staff must not routinely use antiseptic wipes, antiseptic solutions, topical antibiotics, creams, ointments or alternative dressings unless these have been prescribed or explicitly authorised in the individual’s current wound-care instructions.

4.4 Infection Prevention and Control

To reduce the risk of infection, strict hygiene and infection control procedures must be followed:

• Hand hygiene must be completed immediately before preparing equipment, before and after contact with the wound or dressing, after removing gloves and whenever contamination may have occurred.
• Personal protective equipment must be selected according to the assessed risk of exposure to blood or body fluids and the service’s infection prevention and control procedure.
• Gloves do not replace hand hygiene and must be changed between separate procedures and if torn, contaminated or otherwise compromised.
• Sterile single-use equipment must be used where required by the wound-care plan or the specified aseptic technique. Reusable equipment must be cleaned and decontaminated after use in accordance with the manufacturer’s instructions and infection prevention and control procedure.
• Key parts of dressings, equipment and the wound-contact surface must not be touched unless the specified procedure expressly requires this.
• Clinical waste must be segregated, contained, stored and disposed of through the agreed waste route. It must not be placed in the individual’s ordinary household waste unless the relevant waste assessment and local arrangements expressly permit this.
• Sharps must be disposed of immediately at the point of use into an appropriate approved sharps container. Staff must not recap, bend, break or carry an exposed used sharp.
• Any exposure to blood or body fluids, sharps injury, contamination or breach of the required technique must be managed and reported immediately under the service’s exposure-incident procedure.
• The wound-care procedure must be stopped and advice obtained if the required environment, supplies, hygiene facilities, waste arrangements or personal protective equipment are not available.
• Care staff must receive training and a recorded competency assessment in the specific infection-control and wound-care technique they are required to perform. Training alone does not authorise a worker to undertake a delegated wound-care activity.

• Infected wounds must be reported immediately, and appropriate precautions must be taken to prevent the spread of infection.
• Regular hand hygiene and PPE use must be enforced for all staff conducting wound care.
• Sharps disposal bins will be used where necessary to safely dispose of contaminated materials.

4.5 Reporting, Clinical Escalation and Emergency Action

Care staff must report a newly identified wound or any change from the individual’s normal presentation or wound-care plan promptly to the person in charge and to the healthcare professional identified in the personal plan.

Staff must obtain urgent clinical advice where there is:

• increasing redness, heat, swelling, pain, exudate or odour;
• wound enlargement, increasing depth or new tissue damage;
• new blistering, non-blanching redness or discolouration;
• wound-edge breakdown or surrounding skin deterioration;
• unexpected bleeding;
• a dressing that repeatedly leaks, becomes displaced or cannot be removed safely;
• signs that pressure-relieving or repositioning arrangements are ineffective;
• deterioration in circulation, sensation or limb colour;
• a failure to heal within the expected timescale;
• a change in the individual’s general condition; or
• any other observation included in the individual’s escalation plan.

Emergency medical assistance must be requested where the individual has signs of a life-threatening or rapidly deteriorating condition, including uncontrolled bleeding, severe systemic illness, altered consciousness, breathing difficulty or suspected sepsis.

Staff must not delay escalation while waiting for a manager where urgent or emergency assistance is required.

The person receiving the report must document the concern, advice sought, name and role of the professional contacted, time of contact, instructions received and action taken. The personal plan and risk assessment must be reviewed following a significant change or new clinical instruction.

4.6 CIW and Other Statutory Notifications

The registered manager and responsible individual must ensure that wound-related events are considered immediately against regulation 60 and Schedule 3 of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended.

The service provider must notify Care Inspectorate Wales without delay, in writing and in the required form, where the event meets a Schedule 3 notification category. Relevant wound-related events include:

• any category 3 or category 4 pressure damage;
• any unstageable pressure damage;
• a serious accident or injury meeting the regulatory threshold;
• an outbreak of an infectious disease;
• abuse or an allegation of abuse involving the provider, a member of staff or a volunteer;
• an allegation of misconduct by a member of staff;
• an incident reported to the police; or
• an event that prevents, or could prevent, the service from continuing to be provided safely.

Notifications must normally be made within 24 hours of the event becoming known, unless a different statutory timescale applies. Making a CIW notification does not replace any duty to obtain medical assistance, make a safeguarding report, notify the commissioning body, report to the police or make another statutory notification.

The notification record must include:

• the date and time the event was identified;
• the wound site and pressure-damage category where applicable;
• immediate care and protective action taken;
• clinical advice and treatment obtained;
• safeguarding consideration and referrals made;
• communication with the individual and representative;
• the outcome or current condition;
• actions to prevent recurrence; and
• the name of the person who submitted the notification.

4.7 Safeguarding Concerns Associated with Wounds and Pressure Damage

A wound, burn, pressure injury, repeated skin damage, delayed treatment or deterioration may indicate abuse, neglect, improper treatment, organisational neglect or self-neglect. Staff must not assume that a wound is an unavoidable consequence of age, disability, illness or reduced mobility.

A safeguarding concern must be raised in accordance with the service’s safeguarding procedure and the Wales Safeguarding Procedures where there is reason to suspect:

• deliberate injury;
• unexplained or inconsistent injury;
• failure to seek or follow necessary treatment;
• failure to provide prescribed pressure relief, repositioning, nutrition, hydration, continence care or equipment;
• repeated missed wound-care visits or dressing changes;
• unauthorised or inappropriate treatment;
• falsification or omission of records;
• an unexplained delay in reporting deterioration;
• neglect by a family member, informal carer, worker or organisation; or
• any other abuse, neglect or improper treatment.

Staff must take immediate action to protect the individual, preserve relevant evidence and records, make the appropriate safeguarding referral and cooperate with the local authority and other relevant agencies.

A safeguarding referral must not be delayed while an internal investigation is undertaken. An internal review must not replace the statutory safeguarding process.

4.8 Monitoring and Reviewing Wound Healing

Each wound will be reviewed regularly, based on the care plan and individual needs.

Multidisciplinary collaboration with healthcare professionals will ensure optimal wound care outcomes.

Care plans will be updated as wounds heal or if new care strategies are required. For every wound-care observation or intervention, the worker must record:

• the date and exact time;
• the anatomical site of the wound;
• the activity undertaken and the authority for undertaking it;
• the condition of the existing dressing;
• observations permitted by the wound-care plan;
• pain reported or observed;
• the cleansing solution, dressing and other products used;
• consent or refusal;
• the individual’s response;
• any deviation from the plan and the reason;
• concerns identified;
• the person or professional contacted, the time of contact and advice received;
• action taken and follow-up required; and
• the worker’s name and designation.

Entries must be contemporaneous, accurate, legible, attributable and must not contain unapproved abbreviations. Records must not be altered or deleted in a way that obscures the original entry.

Where care is refused, omitted, delayed or cannot be completed, the reason, risks explained, immediate action, escalation and revised arrangements must be recorded.

Wound photography may only be used where it forms part of the agreed clinical or monitoring process, is necessary and proportionate, and is permitted by the organisation’s data-protection and records procedures.

Before a photograph is taken:

• valid consent must be obtained and recorded, or a lawful best-interests decision must be documented where the individual lacks capacity;
• the purpose, intended recipients, storage arrangements and right to withdraw consent for future photographs must be explained;
• the photograph must be taken using organisation-approved equipment and software;
• personal mobile telephones, personal cameras, personal email accounts and unapproved messaging applications must not be used; and
• unnecessary identifying features must be excluded.

Each photograph must be dated, linked accurately to the individual and wound site, stored securely as part of the care or clinical record, accessible only to authorised persons and retained and deleted in accordance with the organisation’s retention schedule.

A photograph must not replace direct assessment, written wound records, clinical escalation or referral.

4.9 Staff Training, Competence and Authorisation

All staff must receive training appropriate to their role in:

• recognising and reporting skin-integrity concerns;
• pressure-damage prevention;
• infection prevention and control;
• consent and mental capacity;
• safeguarding;
• record keeping;
• clinical escalation; and
• CIW incident-notification requirements relevant to their responsibilities.

Only workers who have been formally authorised and assessed as competent may undertake a wound-care intervention or delegated healthcare activity.

Competency assessment must:

• relate to the specific activity and individual;
• include observation of practice;
• be completed by a person with the knowledge and authority to assess the activity;
• identify the limits of the worker’s role;
• be signed and dated;
• specify a review date; and
• be retained in the worker’s training and competency record.

Competence must be reassessed:

• at the interval specified by the delegating professional or provider;
• when the procedure, equipment, dressing or individual’s needs change;
• following an incident, error, complaint or concern;
• where the worker has not performed the activity for a significant period;
• where supervision identifies a concern; or
• before the worker resumes the activity following expiry or withdrawal of delegation.

Staff must not undertake wound care solely because they have previously completed a training course. The provider must maintain evidence of current competence, delegation, supervision and review.

Only trained and competent staff will be permitted to provide wound care. Complex cases will always be referred to healthcare professionals.

4.10 Supporting Service Users with Wound Care

Providing compassionate care and ensuring dignity and comfort during wound care procedures is essential. {{org_field_name}} ensures that:

• Service users are fully informed about their wound care plan.
• Pain management is considered, ensuring procedures are not distressing.
• Emotional support is provided, particularly for service users with long-term or distressing wounds.
• Family members or advocates are engaged where appropriate, ensuring holistic support.

5. Consent, Mental Capacity and Refusal of Care

Valid consent must be obtained before wound observation, assessment, photography or treatment. Consent is an ongoing process and must be confirmed for each intervention.

Staff must explain the proposed care in a way the individual can understand, including:

• what is proposed;
• why it is needed;
• what the procedure involves;
• material risks and discomfort;
• available alternatives;
• what may happen if care is declined; and
• who information may be shared with.

An adult with capacity has the right to refuse wound care, even where staff or healthcare professionals believe the decision is unwise. Staff must not use pressure, threats, deception, restraint or covert treatment to obtain compliance.

Where there is reason to doubt the individual’s capacity to make the specific decision at the relevant time, staff must follow the Mental Capacity Act 2005. Capacity must not be assumed to be absent because of age, disability, diagnosis, communication difficulty or an apparently unwise decision.

Where the individual lacks capacity:

• all practicable steps must first be taken to support the individual to decide;
• any valid and applicable advance decision, health and welfare lasting power of attorney, deputyship or other lawful authority must be identified;
• any decision must be made in the individual’s best interests and be the least restrictive available option;
• consultation and the reasons for the decision must be documented; and
• restraint must not be used unless it is lawful, necessary and proportionate.

A refusal, withdrawal of consent or inability to complete care must be recorded and escalated in accordance with the risks and the individual’s personal plan.

6. Related Policies

This policy aligns with:

• Infection Prevention and Control Policy (DCW17) – Ensuring hygiene and infection control in wound management.
• Safe Care and Treatment Policy (DCW11) – Covering best practices in care delivery.
• Medication Management and Administration Policy (DCW21) – Including pain management and use of prescribed wound care treatments.
• Safeguarding Adults from Abuse and Improper Treatment Policy (DCW13) – Ensuring vulnerable individuals receive appropriate wound care.
• Health and Safety at Work Policy (DCW16) – Covering PPE and safe disposal of wound care materials.

• Delegated Healthcare Activities Policy – setting out the governance, authorisation, accountability, competency and review requirements for delegated wound-care activities.
• Consent and Mental Capacity Policy – covering valid consent, refusal, capacity assessments and best-interests decisions.
• Incident Reporting and CIW Notifications Policy – covering regulation 60 and Schedule 3 notifications, including category 3, category 4 and unstageable pressure damage.
• Data Protection, Confidentiality and Records Management Policy – covering wound records, photographs, secure transfer, access, retention and disposal.
• Pressure Damage Prevention and Management Procedure – covering risk assessment, the Public Health Wales SKIN bundle, repositioning, equipment and escalation.
• Clinical Waste and Sharps Management Procedure – covering segregation, storage, transport, collection, exposure incidents and safe disposal.
• Delegation and Competency Records Procedure – covering individual-specific authorisation, competency evidence, supervision and review.

7. Policy Review and Audit

This policy must be reviewed at least annually and sooner where:

• legislation, statutory guidance, CIW requirements or relevant national clinical guidance changes;
• the service’s statement of purpose changes;
• the service begins or ceases undertaking a wound-care or delegated healthcare activity;
• an incident, safeguarding concern, complaint, CIW notification or investigation identifies a deficiency;
• audit identifies non-compliance;
• a healthcare professional, commissioner or regulator requires a change; or
• new equipment, dressings, products or procedures are introduced.

The provider must audit compliance with this policy. Audits must include, where applicable:

• evidence of valid delegation;
• current staff competency records;
• wound-care records and personal plans;
• consent and capacity documentation;
• infection-control practice;
• availability and expiry dates of supplies;
• clinical-waste and sharps arrangements;
• pressure-damage prevention measures;
• escalation and referral times;
• CIW and safeguarding notifications;
• wound photography and information governance; and
• learning from incidents, complaints and professional feedback.

Audit findings, required actions, responsible persons and completion dates must be recorded. Significant findings must be reported through the service’s governance and quality-of-care review arrangements.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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