NA44-Pressure Area Care and Tissue Viability Policy

Registration Number: {{org_field_registration_no}}

Pressure Area Care and Tissue Viability Policy

1. Purpose

The purpose of this policy is to provide a clear and comprehensive framework for ensuring the safe, effective, and evidence-based management of pressure area care and tissue viability for all service users receiving care from staff supplied by {{org_field_name}}. As a healthcare staffing agency providing temporary registered nurses and healthcare assistants to care homes and similar settings, {{org_field_name}} is committed to reducing the incidence of avoidable pressure ulcers and promoting skin health and integrity. This policy outlines the responsibilities of agency workers and directors in delivering person-centred, safe, and high-quality pressure area care in line with national legislation, including the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, the Care Quality Commission (CQC) Fundamental Standards, NICE Clinical Guidelines (CG179), the European Pressure Ulcer Advisory Panel (EPUAP) guidance, and the Nursing and Midwifery Council (NMC) Code. Preventing pressure ulcers is vital to protecting the dignity, comfort, and health of vulnerable service users and is a fundamental aspect of quality care.

2. Scope

This policy applies to: All temporary registered nurses, healthcare assistants, and other care staff employed or supplied by {{org_field_name}}. All agency workers providing direct or indirect care to individuals who may be at risk of developing pressure ulcers while working in client placements such as care homes, nursing homes, or specialist healthcare settings. Directors and other office-based staff responsible for the training, supervision, and management of temporary workers involved in delivering care.

3. Related Policies

Infection Prevention and Control Policy – Safeguarding Adults Policy – Record Keeping and Documentation Policy – Incident Reporting and Management Policy – Health and Safety Policy – Training and Development Policy – Equality, Diversity, and Inclusion Policy – Consent, Mental Capacity, and Best Interests Policy

4. Definitions

Pressure Ulcer: A localised injury to the skin and/or underlying tissue, usually over a bony prominence, caused by unrelieved pressure, shear, or friction. Tissue Viability: A specialist area of nursing focusing on the management and prevention of tissue damage, including skin integrity, pressure ulcers, and wound management. At Risk: Any individual who, due to limited mobility, chronic illness, poor nutrition, or other risk factors, is susceptible to developing pressure damage.

5. Responsibilities

Directors The directors of {{org_field_name}}, in the absence of a registered manager, are responsible for: Ensuring the implementation, maintenance, and regular review of this policy. Ensuring that all agency workers receive induction and ongoing training in pressure area care and tissue viability. Liaising with client organisations to ensure that staff are familiar with site-specific procedures and equipment. Monitoring compliance through audits, feedback, and incident analysis. Investigating incidents involving pressure ulcer development and taking appropriate action, including supporting learning and service improvement.

Agency Workers All temporary registered nurses, healthcare assistants, and care staff supplied by {{org_field_name}} must: Deliver pressure area care in line with the training provided, this policy, and placement-specific protocols. Take reasonable steps to prevent pressure ulcers in line with NICE guidance and professional best practice. Assess and report risks related to skin integrity and tissue viability. Maintain accurate records of skin assessments, repositioning, and interventions. Communicate effectively with clients, family members, and the multidisciplinary team regarding skin health.

6. Prevention of Pressure Ulcers

Prevention is a key element of pressure area care. Staff must: Identify individuals at risk using recognised tools (e.g., Waterlow or Braden Scale) where applicable. Implement preventative measures, including regular repositioning, pressure-relieving equipment (mattresses, cushions), skin inspection, and personal care. Promote good hydration and nutrition. Educate and encourage service users to reposition where possible and involve them in their care planning. Follow client policies regarding the use of specialist equipment, referrals to tissue viability services, and escalation procedures.

7. Risk Factors for Pressure Ulcers

Staff must be able to identify risk factors, which include: Immobility or reduced mobility. Incontinence. Poor nutritional status. Existing or previous pressure damage. Advanced age. Acute or chronic illness. Neurological impairment. Dehydration. Medical devices (e.g., catheters, oxygen masks) causing pressure on the skin.

8. Skin Assessment

All agency staff must: Carry out or assist with skin assessments where appropriate to their role and competence. Observe and document changes in skin colour, texture, temperature, and integrity. Use recognised pressure ulcer grading systems (EPUAP/NPUAP) where competent, or report findings to a registered professional if not. Report any concerns immediately to the client’s designated nurse or manager.

9. Repositioning

Regular repositioning is essential to reduce pressure damage. Staff must: Reposition individuals following the care plan and professional judgement, considering the individual’s comfort and mobility. Record repositioning clearly and contemporaneously in the service user’s notes. Encourage and assist service users to change position themselves where appropriate.

10. Equipment

Agency staff must: Use pressure-relieving equipment provided by the client, ensuring familiarity with its safe use. Check equipment for suitability, cleanliness, and function prior to use. Report any faults or concerns with equipment immediately to the client manager.

11. Documentation and Record Keeping

Agency workers must: Accurately and legibly document all observations, assessments, repositioning, and interventions relating to skin integrity and tissue viability. Record actions taken to prevent deterioration or promote healing. Report and document any skin damage observed immediately according to client and agency reporting protocols. Complete incident reports where required and escalate concerns without delay.

12. Reporting and Escalation

Any signs of new pressure damage or deterioration must be treated as a serious concern. Agency staff must: Report skin damage immediately to the appropriate client manager or nurse-in-charge. Follow local safeguarding procedures if neglect or lack of appropriate care is suspected. Complete an incident report for {{org_field_name}} for internal investigation and learning. Follow the Duty of Candour when required, including being open and transparent when things go wrong.

13. Training

{{org_field_name}} will ensure that all temporary staff receive training on: Tissue viability and pressure area care principles. Identifying risk factors for pressure ulcers. Pressure ulcer prevention and management techniques. Repositioning techniques and safe use of equipment. Documentation and reporting requirements. The Care Certificate standards (for unregistered staff). Mandatory training will be refreshed annually or as required.

14. Communication and Teamwork

Staff must: Communicate effectively with colleagues, client staff, service users, and families. Contribute to team discussions about care plans and risk assessments. Ensure information regarding skin integrity and repositioning is included in handovers. Respect the choices and dignity of individuals, balancing risk with the person’s rights and preferences.

15. Equality, Diversity, and Inclusion

All individuals are at risk of pressure ulcers, regardless of age, gender, ethnicity, or disability. Agency staff must: Be aware that darker skin tones may display different signs of pressure damage. Ensure that all individuals receive equitable care regardless of background. Take account of cultural, religious, and personal preferences when delivering care.

16. Safeguarding

Agency workers must be alert to the possibility that skin damage may be a sign of neglect or abuse. Any concerns must be: Reported to the placement manager and {{org_field_name}} immediately. Documented fully and factually. Managed in line with the Safeguarding Adults Policy and local safeguarding procedures.

17. Supervision and Support

The directors of {{org_field_name}} will: Provide staff with access to advice and guidance regarding pressure area care and tissue viability. Support staff emotionally and professionally when managing challenging situations. Review incidents related to tissue viability and ensure lessons learned are shared. Implement additional training or supervision where required.

18. Monitoring and Quality Assurance

The directors of {{org_field_name}} will: Regularly audit incident reports and feedback related to tissue viability. Act upon client concerns or complaints relating to pressure area care. Support clients in the management and investigation of pressure-related incidents involving agency staff. Continuously review and improve staff training and induction to ensure good practice is maintained.

19. Policy Review

This policy will be reviewed at least annually by the directors of {{org_field_name}} or earlier if: There are changes to legislation, CQC requirements, or national guidance. Incident trends, audits, or client feedback indicate improvements are needed. Best practice developments emerge relating to tissue viability and pressure area care.

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}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.