Wound Care Audit - Domiciliary Care

Evidence to check

• • Wound care policy is current and relevant to community/home settings
• • Policy reflects local NHS pathways, district nursing arrangements and escalation routes
• • Staff understand what wound care they are authorised and competent to provide
• • Staff know when wound care must be escalated to a nurse, GP, tissue viability nurse or emergency service

Evidence to check

• • Initial wound assessment record or professional wound care plan
• • Wound type, location, size, appearance, exudate, odour, pain and surrounding skin documented
• • Assessment completed by an appropriate competent person
• • Care staff know where to find the current wound guidance

Evidence to check

• • Wound type, treatment aim, dressing schedule and review date recorded
• • Instructions state who is responsible for each part of wound care
• • Products, frequency and escalation triggers are clearly listed
• • Plan reflects the person's preferences, dignity and home circumstances

Evidence to check

• • Visit notes or wound records document appearance, pain, leakage, odour, redness or deterioration
• • Staff record whether dressing was completed, refused, delayed or not required
• • Concerns are escalated to the office and relevant clinical professional
• • Records show follow-up action after deterioration or infection concerns

Evidence to check

• • Consent for wound photography recorded
• • Photographs stored securely in approved systems, not personal phones
• • Photos are dated, linked to the correct person and used appropriately
• • Photography is stopped or reviewed if consent is withdrawn

Evidence to check

• • Escalation records to district nurse, tissue viability nurse, GP, podiatry, hospital or emergency services
• • Clear escalation triggers in the wound care plan
• • Staff can describe signs requiring urgent escalation
• • Follow-up records show advice was received and acted on

Evidence to check

• • Care notes show information shared with the person or family where appropriate
• • Information is provided in a way the person can understand
• • Family or informal carer role is clearly agreed and documented
• • Escalation contacts are available to the person or family

Evidence to check

• • Training records for staff involved in wound care support
• • Competency assessments include observed practice where relevant
• • Staff do not carry out clinical wound care beyond their competence
• • Supervision or spot checks review wound care practice and documentation

Evidence to check

• • Pain level or discomfort recorded in wound or visit notes
• • Staff ask about pain before dressing changes or wound support
• • Analgesia timing considered where this is part of the agreed plan
• • Uncontrolled pain escalated to GP, district nurse or palliative care team where needed

Evidence to check

• • Care plan states required technique or professional guidance
• • Staff follow hand hygiene, clean field and PPE requirements
• • Sterile or clean items are protected from contamination
• • Home environment is assessed and prepared before wound care

Evidence to check

• • Dressing change records sampled
• • Products used match the care plan or professional instruction
• • Any missed, refused or incomplete dressing change is recorded with reason
• • Records are completed at the visit, not retrospectively without explanation

Evidence to check

• • Supplies stored cleanly, dry and protected from contamination
• • Clinical waste arrangements are clear in the person's home
• • Used dressings and PPE disposed of safely
• • Staff know how to manage supply shortages or waste concerns

Evidence to check

• • Products match prescription, formulary or professional wound plan
• • No unapproved creams, dressings or household products used
• • Staff escalate when supplies run out or products are unavailable
• • Changes to products are recorded and authorised by the appropriate professional

Evidence to check

• • Observation or spot check of wound care practice where possible
• • Hand hygiene completed before and after wound care
• • Gloves, aprons and other PPE used appropriately
• • Staff avoid contaminating clean dressings, equipment or records

Evidence to check

• • Staff scenario-based responses
• • Care plan identifies wound type and specific risks
• • Staff understand pressure, diabetes, circulation and infection risks
• • Appropriate professional input is in place for complex or specialist wounds

Evidence to check

• • Nutrition and hydration assessment or care plan
• • Food and fluid monitoring where required
• • Concerns about poor intake, weight loss or dehydration escalated
• • Dietitian, GP or district nurse referral considered where needed

Evidence to check

• • Pressure ulcer grade recorded by a competent professional
• • Pressure-relieving equipment identified and used correctly
• • Repositioning or pressure care guidance included where relevant
• • Safeguarding or incident reporting considered for avoidable or deteriorating pressure damage

Evidence to check

• • Wound measurements, photographs or clinical reviews show progress over time
• • Non-healing or deterioration triggers professional review
• • Treatment plan changed following clinical advice
• • Repeated concerns are not simply recorded without action

Evidence to check

• • Care plan records family or informal carer role
• • Person's consent and preferences are recorded
• • Family carers are given clear instructions and escalation advice where involved
• • Staff identify and escalate unsafe or unsuitable informal wound care

Evidence to check

• • Staff storage and transport arrangements checked
• • Dressings kept in original packaging and protected from contamination
• • Products are in date and allocated to the correct person where required
• • No wound care supplies stored loose, damaged or mixed with contaminated items

Evidence to check

• • Consent to wound care recorded
• • Staff seek consent during visits before wound care
• • Mental capacity assessment completed where needed
• • Best-interest decision recorded where the person lacks capacity for wound care decisions

Evidence to check

• • Staff can identify wounds that may require safeguarding escalation
• • Incident or safeguarding records for unexplained or avoidable wounds
• • Rationale recorded where safeguarding referral is not made
• • Concerns about self-neglect, family neglect or service failure are escalated

Evidence to check

• • Communication records with district nurses, GP, hospital or tissue viability team
• • Professional advice transferred into the care plan promptly
• • Staff are informed of changes to wound care instructions
• • Conflicting instructions are clarified before care continues

Evidence to check

• • Care plan records pressure-relieving equipment and how it should be used
• • Staff check equipment positioning, inflation or correct use where relevant
• • Concerns about equipment failure or unsuitability escalated
• • Equipment effectiveness reviewed after deterioration or new pressure damage

Evidence to check

• • Missed, late or cancelled visit records
• • Impact on wound care reviewed and escalated
• • Alternative visit, clinical contact or family communication arranged where needed
• • Repeated visit issues are investigated and addressed

Evidence to check

• • Care notes mention pain, embarrassment, odour, anxiety, low mood or social withdrawal where relevant
• • Staff provide reassurance and preserve dignity
• • Concerns about emotional wellbeing are escalated
• • Referral or signposting to GP, mental health, counselling or social support considered

Evidence to check

• • Sharps bins available where required
• • Sharps bins are labelled, not overfilled and stored safely
• • Staff know what to do after a sharps injury
• • Sharps are not placed in domestic or general waste

Evidence to check

• • Wound care audit records
• • Audit includes record review, staff knowledge and escalation practice
• • Themes reported through governance or quality meetings
• • Actions from audits are assigned, completed and reviewed

Evidence to check

• • Training needs identified from audits, incidents or supervision
• • Refresher training or updates provided
• • Competency reassessments completed where concerns arise
• • Staff know where to obtain clinical advice

Evidence to check

• • Wound outcomes reviewed over time
• • Healing progress, deterioration and hospital admissions monitored
• • Person's comfort and quality of life considered
• • Outcomes used to improve care planning and escalation

Evidence to check

• • Incident and near-miss records related to wound care
• • Staff know how to report wound care concerns
• • Learning shared through supervision, meetings or staff updates
• • Changes made to reduce recurrence

Evidence to check

• • Care records, wound charts and professional notes are consistent
• • Staff can see current wound care instructions before visits
• • Changes are communicated between shifts and teams
• • No outdated or conflicting wound care guidance remains active

Evidence to check

• • Care plan links wound care to relevant risk assessments
• • Diabetes, circulation, continence and mobility risks considered
• • Falls, pressure damage and infection risks reviewed together
• • Professional referrals made where wider risks affect healing

Evidence to check

• • Environmental risks recorded in the care plan
• • Staff prepare a clean, private and safe space for wound care
• • Lighting and positioning support safe practice
• • Concerns about clutter, pests, poor hygiene, pets or unsafe conditions are escalated

Evidence to check

• • Staff seek consent before wound care
• • Person's preferences about timing, privacy, gender of staff or involvement of family are recorded
• • Staff explain what they are doing and protect dignity
• • Refusals, distress or preferences are recorded and responded to appropriately

Evidence to check

• • Incident reviews consider whether missed visits or poor care contributed to wound deterioration
• • Safeguarding threshold considered where neglect may be involved
• • Actions taken to prevent recurrence
• • Learning shared with staff and managers

Evidence to check

• • Care plan states who is responsible for each wound care task
• • Staff understand what they must do and what they must not do
• • Family or informal carer role is documented where relevant
• • Gaps or overlaps in responsibility are identified and resolved