Tissue Viability and Pressure Ulcer Prevention Audit - Care Homes

Evidence to check

• • Policy is current, reviewed and aligned with NICE, local NHS and tissue viability guidance
• • Policy covers prevention, risk assessment, skin checks, repositioning, equipment, escalation, wound care and reporting
• • Staff can explain how pressure damage is prevented in practice
• • Observed care and sampled records match the policy requirements

Evidence to check

• • Waterlow, Braden or locally approved pressure risk assessment completed on admission
• • Risk score is accurate and supported by clinical judgement
• • Immediate prevention actions are recorded for residents at risk
• • Staff know which residents are at high or increased risk

Evidence to check

• • Review dates are current and in line with policy
• • Assessments are updated after illness, falls, hospital admission, weight loss, reduced mobility, infection or deterioration
• • Changes in risk trigger updated care plan actions
• • Reviews are not completed as tick-box exercises without meaningful changes

Evidence to check

• • Care plan links directly to pressure risk assessment findings
• • Plan includes skin checks, repositioning, equipment, continence, nutrition, hydration and escalation guidance
• • Staff can explain the resident's skin care plan
• • Daily records show the plan is followed in practice

Evidence to check

• • Repositioning frequency is based on assessed risk and resident tolerance
• • Turning charts or digital records are completed in real time
• • Records show position changes actually occurred, not repeated copied entries
• • Missed repositioning is escalated and reviewed for impact

Evidence to check

• • Equipment is matched to the resident's assessed risk and body weight
• • Mattress settings are checked and recorded where required
• • Cushions, mattresses and pumps are clean, functioning and not damaged
• • Faults or delays in equipment provision are reported and escalated

Evidence to check

• • Care plan links mobility, nutrition, hydration and skin integrity
• • Food and fluid concerns are escalated where skin risk increases
• • Mobility support and activity are encouraged where appropriate
• • Dietitian, SALT, GP or nurse input is sought where needed

Evidence to check

• • Training records include pressure ulcer prevention and early signs of damage
• • Staff can describe signs such as non-blanching redness, heat, pain, swelling, discolouration or skin breakdown
• • Staff understand that darker skin tones may show pressure damage differently
• • Early signs are escalated promptly and recorded clearly

Evidence to check

• • Daily skin check records for at-risk residents
• • Records identify skin condition, location and any changes
• • Staff preserve dignity and consent during skin checks
• • Concerns are escalated to senior staff, nurse, GP, community nurse or TVN where needed

Evidence to check

• • Wound assessment records include site, size, depth, grade/category, exudate, odour, pain and surrounding skin
• • Wound photographs are used only with consent and stored securely where applicable
• • Qualified staff review wound progress and deterioration
• • TVN or community nurse involvement is recorded where required

Evidence to check

• • Referral records include date, reason and urgency
• • Advice received is recorded and added to the care plan
• • Delayed responses are chased where risk remains
• • Staff know the escalation pathway for new or worsening wounds

Evidence to check

• • Pressure damage is categorised using the correct grade/category
• • Incident records include location, severity and suspected cause
• • Safeguarding, commissioner, CQC or local reporting requirements are considered
• • Rationale is recorded where safeguarding or notification is considered but not made

Evidence to check

• • Resident and/or representative involvement is recorded
• • Risks and prevention options are explained in a way the resident can understand
• • Resident preferences, comfort and dignity are considered
• • Refusals or choices that increase risk are recorded and reviewed respectfully

Evidence to check

• • Tissue viability or pressure ulcer audit records
• • Audits include care records, skin checks, equipment, staff knowledge and observations where appropriate
• • Actions have owners and timescales
• • Follow-up checks confirm improvements were made

Evidence to check

• • Wound and pressure damage tracker
• • Analysis by resident, location, unit, time, equipment, staffing or care practice
• • Themes are reviewed by managers and clinical leads
• • Actions are taken where trends suggest preventable harm

Evidence to check

• • Pressure ulcer investigation records
• • Investigation reviews risk assessment, care plan, repositioning, equipment, nutrition, hydration and escalation
• • Root causes and contributory factors are identified
• • Learning is shared and care practice is changed where needed

Evidence to check

• • Training and competency records for skin care and wound care tasks
• • Care plan or clinical instruction states which products to use, where and how often
• • Products are used correctly and not shared inappropriately
• • Incorrect application or omissions are identified and addressed

Evidence to check

• • Continence care plan links to skin integrity risks
• • Pads, toileting support, skin cleansing and barrier products are appropriate
• • Skin is checked after continence episodes where required
• • Moisture lesions are distinguished from pressure damage and escalated appropriately

Evidence to check

• • Repositioning records match the care plan schedule
• • Entries are completed at the time care is delivered
• • Records include position used and any refusal or intolerance
• • Gaps or repeated identical entries are investigated

Evidence to check

• • Daily care records or observation confirms bedding and seating checks
• • Mattresses, cushions, sheets and clothing are smooth, dry and correctly positioned
• • Equipment faults are reported promptly
• • Staff understand how small environmental issues can cause skin damage

Evidence to check

• • Nutrition care plan reflects skin healing or pressure risk needs
• • MUST or nutritional screening is current
• • Dietitian, GP or SALT referral made where needed
• • Food and fluid monitoring is completed where the resident is at risk

Evidence to check

• • Governance meeting minutes include tissue viability data and themes
• • New, worsening or avoidable pressure damage is reviewed
• • Actions are tracked through the quality improvement plan
• • Senior leaders monitor whether pressure damage is reducing

Evidence to check

• • Evidence of updates from NICE, NHS, TVN or local guidance being reviewed
• • Staff briefings or training reflect new learning
• • New equipment, products or approaches are risk assessed and evaluated
• • Changes are checked for impact on resident outcomes

Evidence to check

• • Spot checks or competency observations include skin care practice
• • Staff use safe moving and handling, gentle washing, drying and moisturising techniques
• • Resident dignity, consent and comfort are maintained
• • Poor practice is addressed through coaching, supervision or retraining

Evidence to check

• • Pain assessments are completed for residents with wounds or pressure damage
• • Residents with communication difficulties have pain indicators recorded
• • Analgesia or clinical advice is sought where needed
• • Care is adjusted to reduce discomfort during repositioning, dressing changes and personal care

Evidence to check

• • Refusals are recorded clearly and respectfully
• • Capacity, consent and best-interest considerations are documented where relevant
• • Alternative approaches are tried and reviewed
• • Family, advocate or professionals are involved where risk remains high

Evidence to check

• • Audit reviews outcome data, not only form completion
• • Audit checks whether wounds are healing, stabilising or deteriorating
• • Resident comfort, dignity and quality of life are considered
• • Audit findings lead to practical improvements in care