{{org_field_logo}}

{{org_field_name}}

Registration Number: {{org_field_registration_no}}

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Wound Care and Management Policy

1. Purpose

The purpose of this policy is to set out the standards expected of registered nurses, nursing associates where supplied, healthcare assistants and other temporary workers placed by {{org_field_name}} in settings where wound prevention, wound observation or wound care may form part of an assignment.

{{org_field_name}} is a temporary staffing agency and does not itself assess service users, prescribe wound treatment, prepare individual wound-management plans or carry on a regulated activity. The client organisation remains responsible for the clinical service, the service user’s assessment and care plan, the availability of suitable equipment and products, local clinical governance, medical or specialist referral arrangements, and compliance with any requirements applying to it as a registered provider.

Agency workers must nevertheless practise safely, remain within their individual competence and professional scope, follow the client organisation’s authorised care plans and procedures, and raise concerns immediately where care is unsafe, unclear, incomplete or outside their competence.

This policy is informed by applicable health and safety, safeguarding, mental-capacity, data-protection and professional requirements, including the Health and Safety at Work etc. Act 1974, the Control of Substances Hazardous to Health Regulations 2002, the Mental Capacity Act 2005, the Care Act 2014, the UK GDPR and Data Protection Act 2018, the NMC Code, relevant NICE guidance and current national guidance on pressure ulcers and safeguarding.

2. Scope

This policy applies to:

• All registered nurses, nursing associates where applicable, healthcare assistants and other temporary workers employed, engaged or supplied by {{org_field_name}} for assignments in which skin integrity or wound care may be relevant.
• All agency workers who undertake, assist with, observe, document or escalate matters concerning skin integrity, pressure damage or wound care while working within a client organisation.
• The Director and office-based staff responsible for governance, placement oversight, and incident management

This policy does not authorise an agency worker to undertake any clinical procedure. Authority to undertake a procedure arises only where the activity is permitted by law, is included within the worker’s professional or contractual scope, is supported by evidence of current competence, is required by the assignment, and is authorised under the client organisation’s care plan, prescription, protocol or lawful delegation arrangements.

3. Related Policies

• Infection Prevention and Control Policy
• Incident and Accident Reporting Policy
• Safeguarding Adults and Children Policy
• Personal Care and Dignity Policy
• Supervision and Appraisal Policy
• Communication and Record-Keeping Policy
• Code of Conduct
• Clinical Governance Policy

• Consent and Mental Capacity Policy
• Safeguarding Adults Policy
• Safeguarding Children Policy
• Health and Safety Policy
• Control of Substances Hazardous to Health Policy
• Personal Protective Equipment Policy
• Sharps and Needlestick Injury Policy
• Sepsis and Deteriorating Person Escalation Policy
• Medication Management Policy
• Data Protection, Confidentiality and Records Management Policy
• Whistleblowing and Speaking Up Policy
• Training, Competency and Clinical Skills Policy
• Lone Working Policy
• Complaints Policy

4. Legal and professional framework

This policy must be read and applied in accordance with the legal and professional requirements relevant to the worker, the assignment and the client setting. These include, where applicable:

• the Health and Safety at Work etc. Act 1974;
• the Management of Health and Safety at Work Regulations 1999;
• the Control of Substances Hazardous to Health Regulations 2002;
• the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013;
• the Personal Protective Equipment at Work Regulations 1992 and the Personal Protective Equipment at Work (Amendment) Regulations 2022;
• the Mental Capacity Act 2005 and its Code of Practice;
• the Care Act 2014 and applicable statutory safeguarding guidance;
• the Human Rights Act 1998;
• the Equality Act 2010;
• the UK GDPR and Data Protection Act 2018;
• the Health and Social Care Act 2008 and regulations applying to the client organisation where the client carries on a regulated activity;
• the NMC Code and applicable NMC standards and guidance;
• current NICE guidance concerning pressure ulcers, leg ulcers, diabetic foot problems, surgical-site infection and related wound-care matters;
• current national pressure-ulcer safeguarding guidance; and
• applicable local safeguarding, infection-prevention and client clinical procedures.

The direct regulatory duties of a CQC-registered provider remain with the client organisation where it is the entity carrying on the regulated activity. Agency workers must comply with lawful client procedures and must report to both the client and {{org_field_name}} any concern that those procedures, resources or working arrangements expose a person to avoidable harm.

5. Policy Statement

{{org_field_name}} is committed to ensuring that workers supplied to client organisations practise safely, lawfully and within their competence when undertaking or supporting skin-integrity and wound-care activities. The organisation recognises the importance of preventing avoidable wounds and managing existing wounds effectively to reduce the risk of infection, pain, complications, and avoidable harm. All wound care provided by our staff must be:

• Supported by an up-to-date assessment, care plan, prescription, protocol or lawful delegation, as applicable.
• Undertaken only by a worker whose competence has been confirmed for the activity.
• Evidence-based and consistent with current NICE guidance, professional standards, the manufacturer’s instructions and the client organisation’s procedures.
• Undertaken with the person’s valid consent or, where the person lacks capacity, in accordance with a properly made and recorded best-interests decision.
• Person-centred and respectful of dignity, privacy, protected characteristics, cultural requirements and communication needs.
• Undertaken using appropriate infection-prevention precautions and safe disposal arrangements.
• Accurately documented in the client’s authorised record system.
• Escalated without delay where there is deterioration, uncertainty, refusal, suspected infection, possible sepsis, uncontrolled bleeding, unexpected pain, tissue ischaemia, safeguarding risk or any other concern.

6. Division of responsibilities between {{org_field_name}} and the client organisation

{{org_field_name}} is responsible for:

• carrying out appropriate pre-placement checks, including identity, right to work, professional registration, employment history, references, training and competence information;
• supplying workers only to assignments for which they appear suitably qualified and competent;
• obtaining sufficient information from the client about the assignment, required skills, known risks and supervision arrangements;
• making workers aware that they must follow the client’s care plans, clinical procedures, incident-reporting systems and escalation routes;
• responding to concerns, incidents, complaints or competence issues involving an agency worker;
• maintaining appropriate training and competency records;
• cooperating with the client, safeguarding authorities, professional regulators and other lawful investigations; and
• removing a worker from an assignment where there is a material concern about competence, conduct or safety.

The client organisation is responsible for:

• assessing the service user and preparing, approving and reviewing the wound-care plan;
• obtaining and recording consent and undertaking or arranging mental-capacity and best-interests decisions where required;
• prescribing or authorising dressings, medicines, topical preparations and treatment regimes;
• providing suitable dressings, equipment, personal protective equipment, waste facilities and a safe working environment;
• giving agency workers access to relevant records, risk assessments, local procedures and escalation contacts;
• providing appropriate induction, direction and clinical supervision;
• arranging medical, tissue-viability, podiatry, vascular, diabetic-foot or other specialist review;
• maintaining the formal service-user clinical record;
• making statutory notifications where applicable; and
• operating its safeguarding, infection-prevention, incident-management and duty-of-candour processes.

Agency workers must not proceed where these arrangements are absent or materially unsafe. They must protect the person from immediate harm, seek urgent advice and report the concern to the client and {{org_field_name}}.

7. Responsibilities

Director

The Director will:

• Lead on the implementation and governance of this policy
• Review this policy annually or earlier if needed following changes to legislation or best practice
• Ensure that workers are supplied to wound-care assignments only where the agency holds reasonable evidence that their knowledge, training and competence are appropriate to the duties requested by the client.
• Ensure that clinical supervision relating to wound-care practice is provided or overseen by a suitably qualified and competent registered healthcare professional.

• Investigate and manage incidents, complaints, or concerns relating to wound care
• Oversee the maintenance of a wound care training and competency register

• Ensure the agency obtains sufficient information from each client about the wound-care duties, clinical skills and supervision required for an assignment.
• Ensure professional registration is checked before placement and at appropriate intervals thereafter.
• Ensure competence concerns, restrictions on practice and relevant incidents are recorded and acted upon.
• Ensure a suitably qualified clinical adviser is available to support governance decisions where the Director is not clinically qualified.
• Ensure the agency does not create, alter or prescribe service-user wound-care plans unless it is lawfully commissioned and appropriately registered to provide that clinical service.
• Cooperate with client investigations, safeguarding enquiries and professional-regulator referrals.
• Ensure that concerns about unsafe client systems are escalated and, where necessary, that the worker is withdrawn from the assignment.

Registered Nurses

Registered nurses must:

• maintain valid NMC registration and comply with the NMC Code;
• work within their individual competence and any conditions or restrictions applying to their practice;
• confirm that there is a current assessment, care plan, prescription or authorised protocol before commencing wound treatment;
• follow the client organisation’s clinical procedures, formulary, documentation system and escalation pathway;
• undertake wound assessment only where required by the assignment and where competent and authorised to do so;
• obtain and record valid consent before examination or treatment;
• recognise when a person may lack capacity for the relevant decision and follow the client’s Mental Capacity Act procedure;
• use clinical judgement and recognised assessment or classification systems in accordance with client policy;
• check the person’s identity, allergies, sensitivities, pain, relevant medical history and current treatment plan before treatment;
• use only products and equipment authorised for that person and setting;
• not independently prescribe, substitute or materially change a dressing, medicine or treatment plan unless legally authorised and competent to do so;
• monitor the person’s response and escalate deterioration or unexpected findings promptly;
• seek specialist advice where required, including from tissue-viability, diabetic-foot, podiatry, vascular, surgical or medical teams;
• delegate only where lawful and appropriate, and only to a person whose competence has been assessed;
• provide the necessary instructions, supervision and follow-up when delegating;
• document all assessment, treatment, outcomes, advice and escalation accurately and contemporaneously;
• report incidents, safeguarding concerns, product defects, sharps injuries and exposure incidents through both client and agency procedures; and
• speak up and decline to undertake care that is unsafe, unsupported, outside their competence or inconsistent with the authorised care plan.

Healthcare assistants and other unregistered workers

Healthcare assistants and other unregistered workers may undertake or assist with a wound-related activity only where:

• the activity is included within the client-approved care plan or protocol;
• the client organisation permits the activity to be delegated;
• a registered professional has made an appropriate delegation where delegation is required;
• the worker has received suitable training and has been assessed as competent for the specific activity;
• the worker understands the person-specific instructions, expected outcome, limitations and escalation requirements; and
• appropriate supervision and access to advice are available.

The required level of supervision may be direct or indirect, depending on the complexity and risk of the activity, the worker’s competence, the person’s condition and the client’s procedure.

Healthcare assistants must not:

• diagnose the cause of a wound;
• independently prescribe or select treatment;
• independently alter a prescribed wound-care plan;
• undertake an assessment requiring registered professional judgement unless they hold a separate regulated qualification and are authorised to use it;
• apply a medicine or medicated dressing unless this is permitted by the client’s medicines procedure and supported by lawful authorisation;
• undertake sharp debridement; or
• continue with an activity where the wound or the person’s condition is outside the agreed parameters.

Healthcare assistants must observe the wound and the person, follow the authorised care plan, maintain dignity and infection-prevention standards, document the care they have personally delivered and report promptly any pain, bleeding, odour, discharge, redness, heat, swelling, skin discolouration, deterioration, systemic illness or other concern.

8. Principles of Wound Management

All wound care delivered by {{org_field_name}} staff must:

• Promote healing and minimise risk of infection or deterioration
• Be appropriate to the type, size, and cause of the wound
• Respect the wishes, dignity, and comfort of the service user
• Be informed by the latest NICE guidelines, local protocols, and client-specific care plans

• No treatment may be undertaken without an authorised person-specific care plan, prescription or protocol appropriate to the activity.
• Workers must use the least restrictive and least invasive approach consistent with safe and effective care.
• Pain must be assessed before, during and after treatment and escalated where inadequately controlled.
• Known allergies, sensitivities and previous reactions to dressings, adhesives, antiseptics or topical preparations must be checked before use.
• Products must be checked for integrity, expiry date, correct storage and person-specific authorisation.
• Workers must not substitute products solely because the prescribed product is unavailable.
• Treatment must stop and advice must be sought where instructions are unclear, products are unavailable, the wound differs materially from the recorded assessment or the person’s condition has deteriorated.

9. Consent, mental capacity and refusal of care

Valid consent must be obtained before wound examination, photography, measurement, cleansing, dressing or any other intervention. Consent must be voluntary, informed and given by a person who has capacity to make the particular decision at the relevant time.

A person must not be assumed to lack capacity merely because of age, diagnosis, disability, communication difficulty or because they make a decision that others consider unwise.

Where there is reason to doubt capacity, the registered professional must follow the client organisation’s Mental Capacity Act procedure and ensure that the relevant decision-specific capacity assessment is undertaken and recorded by an appropriate person. Where the person lacks capacity, treatment may proceed only where it is lawfully authorised and determined to be in the person’s best interests, taking account of any valid and applicable advance decision, health and welfare attorney, court-appointed deputy or Court of Protection decision.

Agency workers must not use force, restraint or coercion to complete wound care unless this is lawful, necessary, proportionate and authorised under the client’s procedures.

Where a person with capacity refuses wound care, the worker must:

• respect the refusal;
• explain the material risks and available alternatives within the worker’s competence;
• explore whether pain, fear, communication needs, timing, culture or previous experience is affecting the decision;
• document the refusal and information provided;
• notify the responsible registered professional or medical practitioner; and
• escalate urgently where the refusal presents a serious or immediate risk.

Consent must also be obtained before taking a wound image. A photograph must be taken only using client-authorised equipment and systems and must never be retained on a worker’s personal device.

10. Wound Assessment

Before undertaking wound care, the registered nurse must review the available wound assessment, authorised care plan, prescription and relevant clinical records. Where the assignment requires the nurse to undertake or update the wound assessment, this must be done only within the nurse’s competence and the authority granted by the client organisation.

This includes:

• Confirmation of the person’s identity and valid consent.
• Wound type or suspected aetiology, recognising that definitive diagnosis may require specialist or medical assessment.
• Anatomical location.
• Measurements using the client-approved method, including length, width and depth where appropriate.
• Presence of undermining, tracking or sinus formation where the worker is trained and authorised to assess this.
• Wound-bed tissue.
• Exudate amount, colour, consistency and odour.
• Condition of wound edges and surrounding skin.
• Pain at rest and during treatment.
• Bleeding.
• Signs of local infection or spreading infection.
• Signs of compromised circulation, ischaemia or neuropathy.
• Relevant risk factors, including immobility, continence, nutrition, hydration, diabetes, vascular disease, smoking, medication and previous wounds.
• Current dressing or treatment and the person’s response.
• Whether the wound is improving, static or deteriorating.
• Need for urgent, medical or specialist review.
• Date and time of the next planned review.

Wound photographs may support assessment only where permitted by client policy, clinically justified, consented to and stored directly within the client’s authorised clinical-record system. Personal mobile telephones or personal cloud-storage accounts must never be used.

11. Pressure Ulcer Prevention

All staff are responsible for contributing to pressure ulcer prevention by:

• Supporting the use of a validated pressure-ulcer risk-assessment approach required by the client organisation, while recognising that a numerical risk score must not replace clinical judgement.

• Implementing appropriate repositioning schedules and pressure-relieving strategies
• Ensuring good hydration, nutrition, and skin hygiene
• Monitoring for early signs of pressure damage such as redness, discolouration, or skin breakdown
• Reporting concerns promptly to the registered nurse or senior care staff
• Supporting the service user’s comfort and wellbeing during care interventions

• Inspecting skin only with consent and in accordance with the care plan.
• Considering skin tone and recognising that early pressure damage may present differently on darker skin.
• Keeping skin clean and dry and following the authorised moisture-management plan.
• Using repositioning and pressure-redistribution equipment prescribed or identified in the care plan.
• Not using massage or rubbing over areas at risk of pressure damage.
• Ensuring heels are managed in accordance with the individual care plan.
• Checking that pressure-relieving equipment is correctly positioned and functioning.
• Reporting any new non-blanching erythema, persistent discolouration, localised heat, firmness, pain, blistering or skin loss.
• Ensuring deterioration triggers reassessment and review of the prevention plan.

12. Pressure-ulcer classification

Pressure ulcers must be described using the classification system adopted by the client organisation and consistent with current recognised practice. The term “category” must be used where the client uses the recognised category system.

Workers must not reverse-stage or reverse-categorise a healing pressure ulcer. The original category, where known, must remain evident in the record, together with the current clinical description.

Where the extent of damage cannot be confirmed because the wound bed is obscured, or where deep tissue damage is suspected, the worker must use the terminology authorised by the client’s policy and seek review by an appropriately competent professional.

Any disagreement about classification must be escalated and documented rather than resolved by altering another professional’s record without authority.

13. Infection prevention and control

All wound care must be undertaken in accordance with the client organisation’s infection-prevention procedures, risk assessment and the principles of standard infection-control precautions.

Workers must:

• perform hand hygiene at the appropriate stages of care;
• use the personal protective equipment identified by the risk assessment;
• use an aseptic non-touch technique where required by the procedure or client policy;
• prepare a clean and suitable working area;
• avoid placing sterile or clean equipment on contaminated surfaces;
• use single-use products only once and for one person;
• check packaging integrity and expiry dates before use;
• clean or decontaminate reusable equipment in accordance with the manufacturer’s instructions and client procedure;
• dispose of dressings, body-fluid-contaminated waste and sharps in the correct waste stream;
• avoid unnecessary exposure of wounds;
• identify and report suspected infection promptly; and
• follow client isolation or transmission-based precautions where required.

Gloves do not replace hand hygiene. Gloves must be changed between dirty and clean stages and between different wounds where required.

Workers must not use antiseptics, topical antimicrobials or antimicrobial dressings unless authorised in the care plan, prescription or client protocol and appropriate to their competence.

14. Sharps, needlestick injuries and exposure to blood or body fluids

Sharps must be avoided where a safer alternative is available and must be handled and disposed of in accordance with the client organisation’s procedure.

Workers must:

• never recap, bend, break or manually disassemble a used needle unless a specific safe system lawfully requires it;
• dispose of the sharp immediately at the point of use in an approved sharps container;
• not overfill or force an item into a sharps container;
• report missing, unsuitable or overfilled sharps containers before commencing the procedure; and
• use safety-engineered devices where supplied and trained to do so.

Following a needlestick injury, splash to the eyes or mouth, bite, or exposure of broken skin to blood or another potentially infectious body fluid, the worker must:

• stop the activity safely;
• carry out immediate first aid in accordance with the client’s exposure procedure;
• notify the client’s responsible person without delay;
• obtain urgent occupational-health or emergency medical advice;
• complete the client’s incident documentation;
• notify {{org_field_name}} as soon as possible; and
• follow all recommended testing, prophylaxis and follow-up arrangements.

Confidentiality must be maintained. Information about the source person or worker must be shared only where lawful and necessary.

15. Wound products, medicines and dressings

A worker may apply only the dressing, topical product or treatment authorised for the service user through the current care plan, prescription, Patient Specific Direction or other lawful client process.

Before use, the worker must verify:

• the correct service user;
• the correct wound;
• the prescribed or authorised product;
• known allergies and sensitivities;
• the expiry date;
• packaging integrity;
• the correct method of application;
• any required frequency or duration; and
• any contraindications or precautions known to the worker.

Workers must not:

• use another service user’s products;
• use unlabelled or expired products;
• substitute a product without appropriate authorisation;
• cut, combine or alter a product contrary to the manufacturer’s instructions or client protocol;
• apply a medicated product outside the client’s medicines-management procedure; or
• use samples or personally supplied products.

Where the authorised product is unavailable or unsuitable, the worker must not improvise. The matter must be escalated to the responsible registered professional, prescriber or other authorised clinician.

16. High-risk wounds and urgent escalation

The following findings require prompt clinical escalation in accordance with the client’s emergency or urgent-review pathway:

• uncontrolled or unexpected bleeding;
• rapidly increasing pain;
• spreading redness, heat or swelling;
• purulent discharge or a sudden increase in exudate;
• offensive odour accompanied by deterioration;
• fever, rigors, confusion, reduced consciousness or other possible signs of sepsis;
• rapidly progressing skin damage;
• exposed tendon, bone or other deep structure;
• suspected wound dehiscence;
• black, cold, pale, blue or otherwise ischaemic tissue;
• a new or deteriorating diabetic foot wound;
• sudden loss of sensation or circulation;
• suspected necrotising infection;
• signs of anaphylaxis or serious product reaction;
• foreign material within the wound;
• suspected safeguarding-related injury; or
• any finding outside the worker’s competence or the authorised care plan.

Emergency services must be contacted where there is an immediate threat to life or limb. The worker must remain with the person where safe to do so, provide first aid within competence, notify the responsible client professional and inform {{org_field_name}}.

A diabetic foot wound, suspected acute limb ischaemia or rapidly spreading infection must not be managed solely as a routine dressing issue.

17. Documentation and confidentiality

Every wound-related assessment, observation, treatment, refusal, escalation and outcome must be recorded accurately and as soon as practicable in the client organisation’s authorised record system.

Entries must include, where relevant:

• date and time;
• the worker’s name, role and signature or secure electronic identifier;
• confirmation of consent;
• the wound’s location and current clinical description;
• measurements and classification where assessed;
• pain assessment;
• condition of surrounding skin;
• signs of infection, deterioration or other risk;
• care delivered and products used;
• the person’s response;
• advice sought or given;
• the name and role of the person to whom a concern was escalated;
• instructions received;
• planned review or follow-up; and
• any incident, safeguarding or emergency action taken.

Records must be factual, objective, legible and free from judgmental or speculative language. Entries must not be altered retrospectively without a clear, dated and attributable correction or addendum.

Agency workers must not make a duplicate personal record of service-user clinical information unless specifically authorised by the client and {{org_field_name}} for a lawful purpose. Service-user names, wound photographs or clinical details must not be stored on personal telephones, personal email accounts, messaging applications, notebooks or personal cloud services.

Information shared with {{org_field_name}} for incident management must be limited to what is necessary and shared securely. Health information is special-category personal data and requires additional protection under data-protection law.

18. Reporting, incident management and safeguarding

Workers must immediately report to the client organisation:

• a new wound or unexplained skin injury;
• deterioration of an existing wound;
• suspected infection or sepsis;
• a treatment error, omitted treatment or unavailable prescribed product;
• failure or unavailability of pressure-relieving equipment;
• suspected neglect, abuse or organisational abuse;
• a sharps or body-fluid exposure incident;
• a product or equipment defect;
• care delivered outside the authorised plan;
• any concern about the competence or conduct of a worker; and
• any event causing or having the potential to cause harm.

The worker must also notify {{org_field_name}} in accordance with the agency’s incident-reporting procedure. Immediate verbal reporting must be followed by written documentation.

A pressure ulcer must not automatically be treated as a safeguarding concern solely because of its category. Safeguarding action must be considered where there is concern that abuse, neglect, an act of omission, failure to follow the care plan, failure to respond to deterioration, wilful interference with care or a serious organisational failing may have contributed to the harm.

Workers must follow the current national pressure-ulcer safeguarding protocol and the relevant local safeguarding-adults procedure. The client’s safeguarding lead must be informed without delay where the circumstances may meet the Care Act safeguarding criteria. Where the client fails to act and the person remains at risk, the worker must escalate directly through the local safeguarding process and notify {{org_field_name}}.

The worker must preserve relevant evidence, make a factual contemporaneous record and cooperate with any investigation. The worker must not attempt to determine culpability or conduct an independent safeguarding investigation.

19. Children and young people

Where the policy applies to a child or young person, staff must follow the client organisation’s paediatric wound-care, consent and safeguarding procedures.

Consent must be obtained from a person with lawful authority or from a competent young person, as applicable. The child or young person must be involved in decisions in a manner appropriate to their age, understanding and communication needs.

Any unexplained injury, pattern of injury, delayed presentation, inconsistent explanation or concern about neglect must be reported immediately under the client’s safeguarding-children procedure and to {{org_field_name}}.

20. Training and competency

Workers must not be placed into an assignment requiring wound-care skills unless {{org_field_name}} has obtained reasonable evidence that their knowledge, training and competence are suitable for the duties described by the client.

Training requirements must be proportionate to the worker’s role and may include:

• skin integrity and pressure-ulcer prevention;
• wound observation and escalation;
• wound assessment and measurement;
• dressing techniques;
• aseptic non-touch technique;
• infection prevention and waste disposal;
• consent and mental capacity;
• safeguarding;
• sepsis and deteriorating-person recognition;
• diabetic-foot awareness;
• sharps safety and exposure management;
• documentation and wound photography; and
• use of relevant equipment.

Completion of a training course does not by itself establish competence. Competence must be demonstrated through an appropriate combination of qualification, supervised practice, assessment, recent experience and continuing professional development.

Competence must be reassessed where:

• the worker has not recently performed the activity;
• the client requests a skill not previously verified;
• equipment or procedures change;
• an incident or complaint raises concern;
• the worker identifies a learning need;
• practice is observed to be inconsistent with current standards; or
• the worker has a restriction, condition or change affecting practice.

Registered nurses remain professionally responsible for maintaining their own competence and declining work outside their scope. Unregistered workers must not rely on experience alone where the client requires a documented competency assessment.

Refresher training must be provided at intervals determined by risk, client requirements, evidence of competence, changes in guidance and learning from incidents. Where {{org_field_name}} adopts an annual refresher requirement, this is an organisational standard and must be identified as such rather than described as a universal statutory requirement.

21. Supervision and support

{{org_field_name}} will ensure that agency workers have access to appropriate professional support and a clear route for raising concerns.

The client organisation is responsible for providing day-to-day clinical direction, access to relevant records, local induction and supervision appropriate to the assignment.

Registered professionals must be able to obtain timely advice from an appropriate client clinician. Unregistered workers must know:

• who has delegated the task;
• the limits of the delegation;
• the expected outcome;
• when to stop;
• when and how to seek assistance; and
• what must be documented.

Where adequate supervision, equipment, records or clinical support are unavailable, the worker must not continue with a procedure that cannot be performed safely. The concern must be escalated to the client and {{org_field_name}}.

Supervision records must avoid unnecessary inclusion of identifiable service-user information.

22. Collaboration with Client Organisations

Agency staff must:

• Comply with client-specific wound care protocols and documentation systems
• Work collaboratively with client teams and the MDT
• Attend client-provided wound care updates where requested
• Share concerns or observations promptly with the client’s nominated lead for wound care

• Confirm before placement which wound-care procedures form part of the assignment.
• Confirm whether the client requires separate competency assessments or local sign-off.
• Obtain information about lone-working arrangements and access to urgent clinical advice.
• Clarify responsibility for supplying dressings, medicines, equipment and personal protective equipment.
• Clarify the client’s wound-care formulary, documentation system and escalation contacts.
• Clarify who is authorised to amend wound-care plans.
• Clarify incident, safeguarding, duty-of-candour and statutory-notification responsibilities.
• Escalate any discrepancy between the care plan, available products and verbal instructions.
• Ensure that the agency does not direct clinical treatment unless it has lawful authority and suitable clinical governance arrangements.

23. Governance and quality assurance

{{org_field_name}} will monitor the safety and quality of its workforce-supply arrangements through:

• review of wound-related incidents, complaints, safeguarding concerns and client feedback;
• monitoring of professional registration and relevant competence records;
• review of assignment information provided by clients;
• identification of recurring concerns involving a worker, client, procedure or product;
• cooperation with client audits and investigations where lawful and appropriate;
• review of whether workers were placed within verified competence;
• action plans following identified deficiencies;
• dissemination of anonymised learning;
• referral to a professional regulator, safeguarding authority, Disclosure and Barring Service or other body where the legal or professional referral threshold is met; and
• withdrawal of a worker from duties where continued placement may create an unacceptable risk.

{{org_field_name}} will not routinely access service-user clinical records merely for agency audit purposes. Any access to identifiable clinical information must have a lawful basis, be necessary and proportionate, and be agreed with the client organisation.

24. Speaking up and refusal of unsafe work

A worker must stop and seek advice where:

• the proposed care is outside their competence;
• no current care plan, prescription or authority is available;
• the person has not consented;
• capacity or best-interests arrangements are unclear;
• the wound differs significantly from the documented description;
• the correct products, equipment or personal protective equipment are unavailable;
• the environment is unsuitable for safe care;
• infection-prevention requirements cannot be met;
• the worker is instructed to falsify, omit or alter a record;
• the staffing or supervision arrangements are unsafe; or
• continuing would expose the person or worker to avoidable harm.

The worker must take reasonable action to protect the person from immediate harm, notify the responsible client professional and contact {{org_field_name}}. No worker will be subjected to detrimental treatment by {{org_field_name}} for raising a genuine safety concern in good faith.

25. Policy review

This policy will be formally reviewed at least every 12 months and sooner where required because of:

• legislative or regulatory change;
• revised NICE, government or professional guidance;
• a serious incident, safeguarding concern or complaint;
• learning from audit or investigation;
• a change in the services or worker roles supplied by {{org_field_name}};
• a change in CQC registration status or the nature of activities undertaken by the organisation; or
• evidence that the policy is not being implemented effectively.

The policy owner must record the review date, reviewer, changes made, approval date and version number. Superseded versions must be retained in accordance with the organisation’s document-retention procedure.

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