All practitioners must ensure their skills and knowledge are up to date
| Level | Skills and Knowledge |
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I. A fundamental knowledge of the skin.
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II. A fundamental knowledge of maintaining skin integrity and identifying at risk factors.
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III. Is aware of importance of accurate assessment to identify pressure ulcers, Moisture Associated Skin Damage and Device Related Pressure Damage
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IV. Able to recognise signs of skin damage e.g. red areas, signs of shear and friction, signs of wound infection.
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V. Reports any concerns immediately to a senior nurse.
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VI. Aware of and able to locate local guidelines and policies
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VII. Is aware of local and national guidelines and policies that relate to tissue viability, prevention and management of wound infection
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VIII. Is aware of how to order appropriate equipment for management of skin integrity.
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IX. Is aware of own limitations and seeks appropriate advice in a timely manner.
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I. Has an understanding of the Anatomy and Physiology of the skin.
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II. An understanding of holistic accurate patient assessment when planning interventions to include co-morbidities, medical history, surgical history and medications.
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III. An understanding of pharmacological and non- pharmacological approaches to management of acute, chronic and infected wounds.
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IV. Documents results of assessments in a clear manner ensuring evaluation dates and rationale for treatment plans are evidence based.
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V. Is aware of local and national guidelines and policies that relate to tissue viability, prevention and management of wound infection and implements these into clinical practice.
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VI. Is actively involved in health education and health promotion activities with the patients and their families/carers in order to promote skin integrity and/or optimise wound healing?
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VII.Communicates results of assessments, treatment and health education to appropriate members of the multi-disciplinary team.
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VIII. Maintains own professional development e.g. attendance at study days, conferences, reading professional journals and reflects on learning.
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IX. Questions practices that are not evidenced based and reports to nurse in charge or other senior staff member.
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X. Reflects on own practice and maintains professional development.
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XI. Is aware of own limitations and seeks advice.
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XII. Is a nurse prescriber from the formulary.
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I. An in depth knowledge of Anatomy & Physiology of the skin.
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II. Is able to undertake a holistic patient assessment and refer to appropriate members of the multi-disciplinary team.
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III. Is a registered supplementary prescriber and prescribes within the context of their practice.
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IV. Is able to refer to pharmacists for advice and reassessment of medications.
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V. Implements local and national guidelines and policies into practice.
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VI. Facilitates health education and health promotion activities with the patients and their families/carers involving appropriate members of the multi- disciplinary team.
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VII. Has or is working towards a Higher Degree.
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I. Has advanced knowledge of Anatomy & Physiology of the skin.
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II. Is a registered independent prescriber or working towards and prescribes within the context of their practice.
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III. Identifies areas for investigation to enhance care delivery.
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IV. Leads new developments in clinical practice.
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V. Understands and is able to generate new evidence to support care interventions.
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VI. Has or is working towards a Master’s level degree.
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VII. Influences policy decisions at local board level
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Provide effective health improvement and self-management strategies relating to wounds.
| Level | Skills and Knowledge |
|---|---|
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I. Fundamental understanding of the importance of patient education to enable self-management/supported self-management of long-term conditions
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II. Has a fundamental understanding of the psychological impact on the patient and/or carer of having a wound.
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III. Is able to provide the patient with approved, current and appropriate literature on their wound.
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IV. Is able to advise the patient and families on self-care/supported self management
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V. Is aware of services that can assist the patient/ carer to manage their wound.
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VI. Understanding of the impact the wound has on the patients from a cultural and social context.
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VII. Is aware of own limitations and seeks appropriate advice in a timely manner
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I. Is able to recognise through discussion, e.g. questioning the patient and family, when a patient/carer has not understood information regarding their wound and the effect this has on their self-care behaviours and the consequences.
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II. Is able to signpost the patient/carer to relevant information, support groups and counselling to enhance their understanding and self-care/ supported self management.
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III. Is able to develop personal action plans with patients who are at risk of:
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IV. Refers in a timely manner.
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I. Has an in depth knowledge of the need to develop with the patient personal action plans to achieve and maintain health related goals for patients at risk of developing pressure ulcers, or living with a wound.
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I. Has advanced knowledge of the need to develop with the patient personal action plans to achieve and maintain health related goals for patients at risk of developing pressure ulcers, or living with a wound e.g. Leg ulcers, Diabetic Foot Ulceration.
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II. An awareness of counselling techniques and interview methods.
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III. Facilitates and leads education sessions.
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IV. Liaises with relevant patient groups and national bodies e.g. NWCSP and Legs Matter
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V. Is able to undertake an assessment and evaluation of the patient’s health status using tools and techniques that encourage honest, clear communication with the patient and/or carer about active wounds e.g. pressure ulcers and leg ulcers.
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VI. Is actively involved in the design of relevant patient information of the prevention and management of wounds e.g. leg ulcers and pressure ulcers.
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VII. Leads and is involved in improvement methodology and disseminates outcomes.
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VIII. Liaises with and works in partnership with primary & secondary care, third sector, regionally and nationally to shape models of care.
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IX. Involved in quality of life research.
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Practitioners should be able to provide care for patients at risk of developing a pressure ulcer or manage patients with a pressure ulcer, using the best available research and evidence.
| Level | Skills and Knowledge |
|---|---|
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I. Fundamental knowledge of anatomy and physiology of skin.
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II. Is able to differentiate between blanching and non-blanching erythema.
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III. Is able to identify moisture associated skin damage
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IV. Is able to identify device related pressure damage
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V. Is able to offer patients advice regarding daily skin management.
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VI. Is able to teach other care givers the principles of effective skin management
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VII. Is able to support education of pre registration students e.g. nursing, podiatry, physiotherapy on the principles of effective skin management
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VIII. Understands how to use a range of pressure redistributing device
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IX. Understands how to use a range of emollient/barrier products and supports patient/carers in their use
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X. Aware of care bundles e.g. aSSKINg
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XI. Aware of the National Wound Care Strategy Programme - Stop the Pressure Programme
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XII. Escalates concerns when appropriate in a timely manner to a senior staff member.
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XIII. Is aware of own limitations and seeks appropriate advice in a timely manner.
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I. An understanding of Anatomy & Physiology of skin underlying structures.
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II. Able to implement and evaluate appropriate risk assessment and screening tools e.g. PURPOSE-T, Waterlow, MUST.
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III. Able to assess patients at risk status and select appropriate preventative equipment.
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IV. Encourages on-going evaluation of preventative equipment strategies and patient moving, handling and mobilisation plan.
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V. Able to undertake holistic assessment, develop individualised prevention/management plan of care and evaluate care interventions.
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VI. Is able to initiate first pressure ulcer assessment and development of treatment plan (also see wound care capability).
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VII. Understands and is able to apply relevant care bundle e.g. aSSKINg, to skin management.
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VIII. Is aware of and works to local policies, guidelines and pathways.
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IX. Works collaboratively with colleagues to optimise patient concordance.
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X. Understands and is able to refer in a timely manner to relevant members of the MDT.
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I. An in depth understanding of anatomy and physiology of skin and underlying structures.
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II. Is able to appropriately use referral pathways into MDT.
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III. Has an in depth awareness of emerging pressure ulcer prevention and management research.
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IV. Is actively involved in education for patients and carers.
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V. Teaches other staff in relation to pressure ulcer prevention and management using agreed materials.
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I. Has advanced knowledge of Anatomy & Physiology
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II. Has an advanced awareness of emerging pressure ulcer prevention and management research.
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III. Advanced assessment and differential diagnostic skills.
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IV. Has advanced knowledge of pressure area care prevention equipment and strategies.
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V. Actively leads audit and surveillance.
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VI. Can interpret and implement research into clinical practice.
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VII. Advanced knowledge of management and treatment options for complex conditions.
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VIII. Refers directly to other health care professionals for investigations or treatments.
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IX. Develops, delivers and evaluates education and training for staff on the prevention and management of pressure ulcers.
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X. Works with Stakeholders to develop prevention strategies and care pathways to reduce pressure ulcers.
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XI. Develops and disseminates policies related to the prevention and management of pressure ulcers based on current national and international guidelines.
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XII. Facilitates interprets and leads the collection of data for local and national audits.
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XIII. Collaborates in the procurement and evaluation of equipment to prevent pressure ulcers.
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XIV. Develops and undertakes research projects.
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XV. Works with higher educational institutes to develop training that helps to ensure an informed nursing workforce for the future.
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XVI. Contributes to the development of regional and national guidance.
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To provide effective care for people with open wounds practitioners should be able to demonstrate the following.
| Level | Skills and Knowledge |
|---|---|
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I. Has a fundamental understanding of the principles of wound healing.
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II. Accesses and uses referral pathways appropriately.
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III. Recognise signs of deterioration/or concerns and knows how to report concerns.
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IV. Understands the importance of wound cleansing
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V. Ability to select and use appropriate wound cleansing techniques
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VI. Carries out dressing changes as instructed and within the scope of their practice.
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VII. Ability to accurately document care provided potentially using clinical photography
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VIII. Encourages the patient/carer to adhere with recommended dressing regimens.
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IX. Distinguishes wound product types/ categories and has a fundamental knowledge of the mechanism of action and application and removal and/or knows where to locate information.
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X. Demonstrates a fundamental understanding of infection control procedures (e.g. hand hygiene, ANTT and the use of PPE) and techniques to minimise cross infection.
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XI. Is aware of own limitations and seeks appropriate advice in a timely manner.
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I. A working knowledge of wound management related local and national guidance for treatment plans are evidence based.
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II. Able to recognise and diagnose wounds by aetiology.
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III. An understanding of the wound healing process and the potential complications of/or potential delays to that process.
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IV. Understand the impact of biofilm on wound healing
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V. Aware of antibiofilm strategies
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VI. Understands the need and principles of debridement and wound bed management.
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VII. Able to carry out agreed wound management techniques.
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VIII. A broad knowledge of available dressing products, their modes of action and appropriate use.
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IX. An understanding of the psychological impact of a wound on the patient.
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X. Able to confirm that the patient and or carer understands the purpose and nature of planned care.
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XI. Makes timely and appropriate referrals for advanced wound management.
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XII. Able to recognise the clinical signs and symptoms of wound infection (local and systemic) and refers quickly and appropriately.
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XIII. Carries out Fundamental microbiological sampling (e.g. wound swabbing) and ensures that the results are interpreted by an appropriately skilled colleague.
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XIV. Works effectively with the multidisciplinary team to implement preventative strategies that will expedite healing, prevent complications and minimize recurrence
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XV. Works collaboratively with colleagues to optimise patient concordance
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XVI. Aware of their local wound management formulary group and related groups i.e. area prescribing committee
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I. An in-depth knowledge of debridement techniques and able to select appropriate method of debridement
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II. Able to carry out debridement techniques of wounds within the scope of their practice e.g. autolytic, monofilament pad, larvae, or curette debridement
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III. Recognises when to and refers the patient for appropriate debridement techniques.
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IV. An in depth understanding of the wound healing process and its potential complications.
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V. Has an in-depth knowledge of dressing products, mode of action, and appropriate use.
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VI. Is a supplementary prescriber, and prescribes within the context of their practice.
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VII. Recognises the signs and symptoms of wound infection (local and systemtic) and manages them effectively.
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VIII. Ensures the results of investigations are seen and interpreted by appropriately skilled colleagues.
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IX. Recognises when to refer to appropriately skilled health care professionals for investigations and or treatment.
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X. Evaluates wound care interventions to develop evidence based individualised care plans.
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XI. An in-depth knowledge of guidance related to wound management.
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XII. An in depth understanding of the psychological impact of wounds.
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I. Has advanced understanding of wound healing process and its potential complications.
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II. Advanced understanding of the psychological impact of wounds.
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III. Able to classify disease specific processes by interpreting the results of investigations e.g. microbiological sampling.
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IV. Contributes expert opinion on the development of care plans for complex wounds.
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V. Critically analyses wound care interventions to develop evidence based individualised care plans.
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VI. Acts as the patient advocate arranging and chairing multi-agency case conferences.
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VII. Applies high level clinical reasoning in all aspects of the management of patients with wounds.
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VIII. Contributes to the development of local referral pathways, policies and guidelines.
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IX. Is an independent prescriber, and prescribes within the context of their practice.
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X. Able to carry out sharp debridement with a scalpel within the scope of their practice.
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XI. Supports less experienced colleagues in developing debridement skills.
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XII. Demonstrates advanced knowledge of debridement techniques
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XIII. Recognises the need to refer for surgical debridement when appropriate (e.g. Osteomyelitis, ischaemia).
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XIV. Recognises deep infection/spreading infection and demonstrates timely and effective referrals appropriately. Commences systemic therapy, facilitating admission to hospital if appropriate using local pathways.
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XVI. Has advanced knowledge of preventative strategies and equipment that can be used to expediate healing, prevent deterioration, facilitate independent living and reduce wound recurrence.
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XVII. Carries out, supervises others to carry out advanced wound management techniques.
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XVIII. Directly refers to appropriately skilled colleagues for investigations and or treatment e.g. dermatology, vascular surgery, podiatry orthotics’, cardiologist, biopsy, x-ray, duplex.
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XIX. Advanced knowledge of dressing products, mode of action, and appropriate use.
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XX. Makes product choices based on consideration of clinical indications, wound type, patient needs and formulary and budgetary directives.
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XXI. Contributes to the development of relevant national guidance.
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XXII. Provides expert opinion to their formulary group and other related wound management groups.
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XXIII. Facilitates the development of local referral pathways and enables their implementation.
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XXIV. Works with stakeholders to develop and implement care pathways for patients with open wounds.
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XXV. Proactively identifies the need for clinical or service innovations to effectively manage wounds and takes a leading role in designing and implementing these innovations.
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XXVI. Leads in the integration of theoretical wound management into clinical practice and collaborates with higher educational institutions and other educational providers to achieve this.
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XXVII. Ensures there is local capacity to facilitate support and mentor colleagues seeking to develop their clinical practice (e.g. sharp debridement, larvae, versajet, ABPI, Toe pressures).
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XXVIII. Leads in the integration of theoretical wound management into clinical practice and collaborates with higher educational institutions and other educational providers to achieve this.
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XXIX. Leads in the evaluation of new and novel wound care products.
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XXX. Provides clinical leadership in advanced wound debridement techniques, and expert opinion on debridement products, techniques and indications in local and national expert groups.
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XXXI. Leads in the establishment of working relationships with the multidisciplinary team.
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XXXII. Collaborates with higher educational institutions and other educational providers on meeting the educational needs of the nursing workforce in relation to wound management.
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XXXIII. Provides expert opinion on dressings and medical devices in local and national wound formulary and associated groups.
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XXXIV. Employs an advanced knowledge of supportive strategies to facilitate healing (e.g. counselling, weight management, role of dietician, offloading).
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Practitioners should be able to provide effective care for patients with lower limb ulcerations conditions and demonstrate the following competencies.
| Level | Skills and Knowledge |
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I. Fundamental knowledge of the Anatomy & Physiology of the veins and arteries in the lower limb.
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II. Is able to provide patients advice on how to improve circulation, such as movement and elevation
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III. Encourages the patient/carer to adhere with recommended management plan.
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IV. Is able to assess the condition of skin to the lower leg.
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V. Awareness of the importance of lower leg skin care
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VI. Able to wash limbs, remove skin scales and apply emollients in correct manner.
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VII. Awareness of importance of prevention of ulceration.
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VIII. Ability to apply compression hosiery.
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IX. Ability to measure and size for ‘off the shelf’ hosiery
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X. Understands when to refer patient to other health care professionals.
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XI. Is able to report care interventions and concerns to the senior nurse and/or other health care professionals in a.
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XII. Is aware of own limitations and seeks appropriate advice in a timely manner.
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XIII. Is aware and works to local policies, guidelines, pathways.
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I. An understanding of Anatomy & Physiology of veins, arteries, lymphatic system in the lower limb.
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II. Is able to identify and use appropriate assessment tools/care pathways.
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III. Is able to develop personal action plans with patients who are at risk of:
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IV. Recognises the importance of ‘immediate and necessary care’ as defined by the NWCSP.
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V. Is able to select appropriate ‘first aid’ compression upto 20 mmHg.
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VI. Is aware of national timescale for referral and assessment and understands the impact of these in relation to patient outcomes.
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VII. Is able to identify a range of potential causes of ulceration in the lower limb.
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IX. Competent at performing ABPI (Ankle Brachial Pressure Index) assessment.
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VIII. Able to undertake holistic assessment and develop individualised management plan/makes recommendations for further assessments.
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X. Able to confirm to the patient and or carer understanding of the purpose and the nature of management plan.
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XI. Understanding of the principles of lower limb management strategies.
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XII. Able to recognise causes of lower limb ulceration.
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XIII. Ability to be able to assess for signs/severity of oedema and lymphoedema.
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XIV. Recognises the benefits of strong compression therapy.
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XV. Recognise benefits of oedema reduction.
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XVI. Ability to measure and order made to measure hosiery
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XVII. Understanding of psychological impact of lower limb ulceration.
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XVIII. Aware of the need for onward referral to vascular services to assess for venous incompetency.
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XIX. Works collaboratively with colleagues to optimise patient concordance.
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XX. Initiates strategies to prevent recurrence of ulceration.
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XXI. Recognises need for timely onward referrals.
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XXII. Is able to access and use referral pathways as appropriate.
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XXIII. Escalates concerns when appropriate
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XXIV. Recognises when emergency referral is required.
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I. In depth understanding of the pathophysiology of venous, arterial, lymphatic and diabetic foot ulceration.
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II. Recognising the importance of diagnosis of underlying disease process.
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III. Recognises and acts on the requirement of further assessment such as ABPI (Ankle Brachial Pressure Index).
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V. Ability to accurately interpret ABPI results.
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VI. Ability to diagnose underlying cause of ulceration.
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VII. Recognises other factors that could impact on patient healing.
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VIII. Demonstrates appropriate use of referral pathways into MDT.
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IX. Ability to clearly and concisely explain to patient the underlying cause of the ulceration.
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X. Ability to clearly and concisely explain to the patient the benefits of compression therapy and how compression works.
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XI. Is able to recognise dermatological conditions associated with lower limb conditions e.g. Varicose eczema, Haemosiderin staining, atrophy blanche.
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XII. Recognises the need for compression therapy.
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XIII. Knowledge of all current options of compression therapy.
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XIV. In depth understanding of advantages and disadvantages of certain compression systems.
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XV. Able to demonstrate competency at application of compression bandaging using a variety of systems.
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XVI. Able to demonstrate competency at selection and application of alternative compression systems e.g. compression hosiery kits, compression wrap systems.
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XVII. In-depth understanding of the psychological impact of lower limb ulceration.
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XVIII. Uses strategies to improve patient compliance.
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XIX. Evaluates interventions to develop evidence based individualised care plans.
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XX. Is actively involved in the education of patients and carers.
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XXI. Aware of all options to aid prevention of recurrence.
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XXII. Understands the reasons for and encourages onward referral to vascular services to assess for venous incompetency/the need for intervention to reduce time to healing and reduce risk of recurrence.
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XXIII. Teaches other staff in relation to lower limb ulceration management using agreed materials.
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XXIV. Knowledge of national guidance relating to lower limb ulceration.
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XXV. Is aware of emerging evidence in the management of lower limb ulceration.
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I. Advanced knowledge of Anatomy & Physiology of lower limb
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II. Has advanced understanding of underlying disease process.
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III. Possesses advanced assessment skills and differential diagnostic skills.
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IV. Able to diagnose and develop treatment plans for complex lower limb ulceration.
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V. Advanced knowledge of management and treatment options for complex conditions.
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VI. Able to assess pulse status in lower limbs.
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VII. Able to interpret Doppler wave forms/doppler auscultation.
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VIII. Competent at performing Toe Pressure measurement.
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IX. Can determine prominent factors in mixed disease ulceration.
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X. Ability to refer directly for investigations or treatments
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XI. Advanced knowledge of equipment/products/modalities for treatment of lower limb ulceration.
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XII. Advanced knowledge of strategies to help prevent bandage slippage.
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XIII. Advanced knowledge in the use of adjunct compression techniques e.g. compression at 40 – 60 mmHg, strapping techniques, retromalleolar padding.
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XIV. Advanced knowledge of supportive strategies to facilitate healing (e.g. weight management, physiotherapy, offloading, etc.).
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XV. Understands the importance of gait/footwear assessment and impact on healing.
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XVI. Advanced knowledge of prevention of recurrence strategies.
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XVII. Develops, delivers and evaluates education and training for the multi-disciplinary on the management and prevention of lower limb ulceration.
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XVIII. Monitors prevalence, time to assessment and healing rates for patients with venous ulceration, benchmarks this against national standards of assessment/escalation.
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XIX. Ability to request imaging such as x-ray or venous/arterial duplex scanning.
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XX. Ability to interpret imaging findings.
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XXI. Collaborates with the MDT to establish clear referral pathways between relevant services e.g. dermatology, plastic, diabetic MDT vascular surgery.
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XXII. Ability to directly refer to other specialities.
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XXIII. Contributes to the development of regional and national guidance.
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XXIV. Develops and disseminates polices related to the management of lower limb ulceration based on current national and international guidelines.
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XXV. Works with stakeholders to develop care pathways to improve healing rates of patients with ulceration and prevent amputations.
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XXVI. Facilitates, interprets and leads the collection of data for local and national audits
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XXVII. Develops and undertakes research projects in relation to lower limb ulceration.
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XXVIII. Works with higher educational institutes to develop training/education in relation to lower limb ulceration.
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Practitioners should be able to provide effective care for patients with dermatological conditions associated with tissue viability and demonstrate the following competencies.
| Level | Skills and Knowledge |
|---|---|
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I. Fundamental knowledge of the appearance of healthy skin.
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II. Basic understanding of when to refer patient to a colleague when skin abnormality is suspected.
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III. Has an understanding of the changes in aging skin and how this increases risk of developing skin problems.
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IV. Is able to report care interventions and concerns to the senior nurse and/or other health care professionals in a timely manner.
|
|
|
V. Understands scope of role and when to seek advice.
|
|
|
VI. Is aware of own limitations and seeks appropriate advice in a timely manner.
|
|
|
I. Has an understanding of the appearance of healthy skin and is able to recognise simple skin conditions eg dry skin, macerated skin, , moisture associated skin damage.
|
|
|
II. Is able to identify and use appropriate assessment tools.
|
|
|
III. Is able to identify suspicious/unidentified skin lesions and refers in a timely manner.
|
|
|
I. Is able to recognise dermatological conditions associated with wounds e.g. malignant skin lesions, Pyoderma, vasculitis, varicose eczema.
|
|
|
II. Has an in depth understanding of the appearance of healthy skin and is able to recognise a number ofskin conditions eg contact dermatitis, atopic eczema, moisture associated skin damage, psoriasis, covid/viral infections etc.
|
|
|
III. Is able to recognise and understand the relationship with underlying medical conditions and the skin e.g. autoimmune diseases.
|
|
|
IV. Able to use a range of terms to describe rashes and lesions appropriately e.g. atrophy, bulla, dermatitis, hive, keloid, macule, fissure, hyperkeratotic, plaque, telangiectasia, purpura etc.
|
|
|
V. Demonstrates appropriate use of referral pathways into MDT.
|
|
|
VI. Is involved in development of pathways for ageing skin.
|
|
|
I. Has an advanced understanding of dermatological conditions and associated investigations e.g. biopsy and allergy testing.
|
|
|
II. Possesses advanced assessment skills and differential diagnostic skills.
|
|
|
III. Able to diagnose and develop treatment plans for non-malignant dermatological skin conditions including appropriate use of systemic or topical medication based on local and /or national stewardship policies.
|
|
|
IV. Refers patients directly to dermatology service.
|
|
|
V. Collaborates with the MDT to establish clear referral pathways between relevant services e.g. dermatology, plastic & vascular surgery.
|
To provide effective care for people with tissue viability conditions nurses should be able to demonstrate pharmaceutical knowledge and associated clinical skills
| Level | Skills and Knowledge |
|---|---|
|
I. Has a basic understanding of common pharmaceutical products and their uses e.g. soap substitutes, emollients and is able to demonstrate how to apply them.
|
|
|
II. Has a basic understanding of common dressings on the wound management formulary and knows how to apply and remove them safely.
|
|
|
III. Has an awareness of AMS
|
|
|
IV. Is aware of own limitations.
|
|
|
I. Has an understanding of the modes of action and effects of relevant medicines, including pharmacokinetics and pharmacodynamics.
|
|
|
II. Has an understanding of potential unwanted effects (e.g. allergic reactions, drug interactions, indications, precautions, contraindications).
|
|
|
III. Maintains an up to date knowledge of relevant products, formulations, doses, costs, and supply routes.
|
|
|
IV. Has an understanding of potential misuse of relevant medicines.
|
|
|
V. Demonstrates an understanding of non-drug treatment options including referral pathways.
|
|
|
VI. Adheres to formulary compliance/ good prescribing and effective stock management to avoid waste, manage budget and enhance cost effectiveness.
|
|
|
VII. Gives clear information to the patient and or carer about their medication/s including how/when to take/administer the medication, where to obtain them, possible side effects and signposts where and when to seek medical advice should these arise.
|
|
|
I. In depth awareness of patient specific factors (e.g. age, renal , cardiac impairment, immunosuppression) and the impact on pharmacokinetics and pharmacodynamics and the need for regimen adjustment where appropriate.
|
|
|
II. Works within local protocols for prescribing.
|
|
|
III. Understands local drug budgetary constraints and is able to provide rationale for prescribing decisions.
|
|
|
I. Advanced awareness of patient specific factors (e.g. age, renal , cardiac impairment, immunosuppression) and the impact on pharmacokinetics and pharmacodynamics and the need for regimen adjustment where appropriate.
|
|
|
II. Able to request and interpret renal, liver function tests.
|
|
|
III. Establishes, monitors and makes changes to medication regimens within the scope of the care plan and in light of therapeutic objectives.
|
|
|
IV. Aware of common medication errors and medication error strategies.
|
|
|
V. Aware of and accepts legal and ethical responsibility for prescribing within the context of local and national formularies.
|
|
|
VI. Plays a role in developing local protocols for prescribing requests.
|
|
|
VII. Uses tools to improve prescribing practice (e.g. reviews prescribing data, feedback from patients, pharmacists and medical colleagues).
|
|
|
VIII. Reports prescribing errors and near misses, and reviews practice to prevent recurrence.
|
|
|
IX. Understands local drug budgetary constraints and can discuss them with colleagues and patients.
|
|
|
X. Provides support and advice to other prescribers when appropriate.
|
|
|
XI. Facilitates staff to achieve prescribing qualifications.
|
|
|
XII. Negotiates treatment plans (including, where appropriate, non-pharmacological therapies) that both the patient and prescriber are satisfied with.
|
|
|
XIII. Advanced awareness of and leads on local initiatives to ensure antimicrobial stewardship in relation to patients with wounds.
|
|
|
XIV. Advanced awareness of national drug budgetary constraints and can discuss them with colleagues and patients.
|
|
|
XV. Takes a leading role in supporting and advising other prescribing colleagues as part of a teaching program or when requested.
|
|
|
XVI. Leads collaborative working and networking with higher educational institutions and other members of the MDT and independent agencies to meet the needs of the population in relation to tissue viability.
|
Practitioners should be able to provide care for patients with a tissue viability need using the best available research and evidence
| Level | Skills and Knowledge |
|---|---|
|
I. Able to assist with audit data collection.
|
|
|
II. Fundamental understanding of the importance of research and audit/ data collection methods.
|
|
|
III. Is aware of own limitations and seeks appropriate advice in a timely manner.
|
|
|
I. Understands the importance of implementing and evaluating interventions using the research/evidence.
|
|
|
II. Is able to locate research and evidence.
|
|
|
III. Is aware of current contemporaneous literature that underpins practice – best practice statements nice guidance local policy and procedure.
|
|
|
IV. Understands need the for continual audit/clinical governance.
|
|
|
V. Can use research and audit data to evaluate practice.
|
|
|
I. Is able to lead an audit/clinical governance project.
|
|
|
II. Is able to critically appraise research and evidence.
|
|
|
III. Understands and contributes to quality improvement/PDSA cycles.
|
|
|
IV. Is able to question practice and use research and evidence to support new practices.
|
|
|
V. Aware of process of Health Research Authority ethical and research approval.
|
|
|
I. Designs, manages and leads clinical audit/clinical governance projects including the analysis of results and report writing.
|
|
|
II. Leads on quality improvement/PDSA methodology.
|
|
|
III. Develops and monitors service/organisation metrics.
|
|
|
IV. Possesses advanced knowledge of research methodology.
|
|
|
V. Has completed or is in the process of undertaking research training e.g. Good Clinical Practice education.
|
|
|
VI. Devises Implementation plans to integrate research and audit into clinical practice.
|
|
|
VII. Publishes in peer reviewed journals, disseminates findings at peer reviewed events locally nationally and internationally.
|
|
|
VIII. Leads the design, implementation and analysis, critique and writing up of research studies.
|
|
|
IX. Works with clinical research governance team about undertaking Principal Investigator role for research.
|
|
|
X. Has completed a recognised training/education programme in research methods.
|
|
|
XI. Is able to navigate Health Research Authority ethical and research approval process.
|
|
|
XII. Designs research studies acting as Chief Investigator.
|
All practitioners must ensure patients are cared for in a safe environment
| Level | Skills and Knowledge |
|---|---|
|
I. Fundamental understanding of the importance of maintaining a safe environment.
|
|
|
II. Reports any concerns of neglect/safeguarding to the relevant authorities immediately.
|
|
|
III. Is aware of relevant legislation and their principles e.g. safeguarding, deprivation of liberty safeguards (Liberty Protection Safeguards from 2022), Duty of Candour, Mental Capacity Act (2005) and the Mental health Act (2017).
|
|
|
IV. Is aware of own limitations and seeks appropriate advice in a timely manner.
|
|
|
I. Has an understanding of the deprivation of liberty safeguards (Liberty Protection Safeguards from 2022), safeguarding, Mental Capacity Act (2005) and Mental Health Act (2017).
|
|
|
II. Is able to identify safeguarding and mental health teams in their own organisation and knows how to refer to them.
|
|
|
III. Is aware of the procedure for referring to safeguarding and mental health specialists.
|
|
|
IV. Documents results of referrals to services in patients notes.
|
|
|
I. Refers to the safeguarding and mental health specialists in a timely fashion.
|
|
|
II. Offers support to Level 1 and Level 2 staff in following the process for referring to the correct specialists for safeguarding and mental health.
|
|
|
III. Can identify training needs of practitioners in relation to safeguarding and refers to the appropriate training provider.
|
|
|
IV. Able to accurately document MCA assessment
|
|
|
I. Has advanced understanding of the deprivation of liberty safeguards (Liberty Protection Safeguards from 2022), safeguarding, Mental Capacity Act (2005), the Mental Health Act (2017).
|
|
|
II. Liaises with safeguarding and mental health specialists in their own area and refers to them as appropriate.
|
|
|
III. Educates staff regarding safeguarding, mental capacity, and mental health in relation to tissue viability.
|
|
|
IV. Provides expert wound care advice in safeguarding investigations.
|
|
|
V. Develops guidelines and policies for tissue viability that integrate safeguarding, mental capacity and mental health in treatment and intervention plans.
|
|
|
VI. Provides guidance and works with local MCA leads on complex cases
|
Practitioners working in tissue viability should be able to lead and manage a case load of patients while working with/alongside MDT as appropriate.
| Level | Skills and Knowledge |
|---|---|
|
I. Fundamental understanding of the importance of MDT working.
|
|
|
II. Seeks assistance and advice where necessary.
|
|
|
III. Is aware of own limitations and seeks appropriate advice in a timely manner.
|
|
|
IV: Assesses own learning needs and attends relevant educational events.
|
|
|
I. Understands the need for clinical leadership e.g. facilitates teaching sessions for staff and/or patients.
|
|
|
II. Is able to manage and appropriately prioritise a case load of patients
|
|
|
III. Is aware of local and national polices & guidance that are relevant to the clinical area.
|
|
|
IV. Is an integrated member of the MDT.
|
|
|
V. Acts as a role model
|
|
|
I. In depth understanding of national and local policies and guidance and adheres to these in practice.
|
|
|
II. Liaises and refers to relevant members of the MDT in a timely manner.
|
|
|
III. Acts as a preceptor to newly registered staff and mentor staff new to the area.
|
|
|
IV. Leads with integrity
|
|
|
I. Demonstrates an advanced understanding of clinical leadership for the service and within the MDT.
|
|
|
II. Leads MDT meetings.
|
|
|
III. Reviews local policies and guidance and challenges as appropriate.
|
|
|
IV. Provides expert knowledge and skills to staff.
|
|
|
V. Participates in the development of professional networks relevant to tissue viability.
|
|
|
VI. Is responsible for ensuring products and therapies are available for patients.
|
|
|
VII. Can demonstrate effective budgetary control measures.
|
|
|
VIII. Can demonstrate examples of effective team management.
|
|
|
IX. Participates in decision making at senior level e.g. policy and guidance development.
|
|
|
X. Participates in and writes policies, guidelines, pathways and procedures and relevant documentation underpinned by the best available research and evidence.
|
|
|
XI. Leads TV networks both locally and nationally and works in partnership with other professional groups e.g. infection prevention, microbiology.
|
|
|
XII. Is recognised as a key opinion leader in TV by peers, academics and industrial partners.
|
|
|
XIII. Develops and manages strategies to ensure cost effective, evidence based interventions.
|
|
|
XIV. Reviews the needs of the service at least annually and reports to senior management.
|
To provide effective evidence based interventions in the early identification and management of surgical site infection
| Level | Skills and Knowledge |
|---|---|
|
I. Has a fundamental understanding of the principles of prevention, identification and management of surgical site infection
|
|
|
II. Is able to recognise the clinical signs and symptoms of surgical site infection and escalates appropriately
|
|
|
III. Is able to undertake basic microbiological sampling (e.g. wound swabbing)
|
|
|
IV. Is aware of Antimicrobial Resistance and Antimicrobial Stewardship and knows where to locate local guidance
|
|
|
V. Is aware of the importance of surgical site infection care bundles for the care of patients pre, intra and post operatively
|
|
|
VI. Is able to recognise high risk patient groups
|
|
|
VII. Is able to select and apply a simple appropriate post-operative dressing to cover the wound
|
|
|
VIII. Is aware of own limitations and seeks appropriate advice in a timely manner.
|
|
|
I. An understanding and can describe the rationale of steps taken to prepare and protect patients in the prevention of surgical site infection
|
|
|
II. Implements surgical site infection care bundles for the care of patients pre, intra and post operatively
|
|
|
III. Is able to select and apply both simple and interactive post-operative dressings
|
|
|
IV. Recognises the clinical signs and symptoms of wound infection (local, systemic and sepsis) and appropriately refers in a timely manner.
|
|
|
V. Ability to undertake a range of microbiology sampling (e.g. deep cavity swabbing) and ensures that the results are interpreted by an appropriately skilled colleague.
|
|
|
VI. Aware of available post operative dressing products, their modes of action and appropriate use.
|
|
|
VII. Aware of local antimicrobial formulary
|
|
|
I. Has a in depth understanding of the principles of prevention, identification and management of surgical site infection
|
|
|
II. Able to distinguish cause of wound dehiscence eg surgical site infection, trauma, pressure, technical failure etc
|
|
|
III. Is able to appropriately manage surgical site infection, including biofilm, local, systematic and/or escalates appropriately
|
|
|
IV. An in depth understanding of the rationale of the steps taken to prepare and protect patients in the prevention of surgical site infection and is able to teach others
|
|
|
V. Provides advice and support to other practitioners in relation to the appropriate selection of postoperative dressings and wound types and can list the advantages and limitations of each
|
|
|
VI. Implements strategies to reduce the risk of surgical site infection in high risk patient groups
|
|
|
VII. Is able to differentiate between superficial, deep and organ space post-operative wound infection and liaises with appropriate colleagues
|
|
|
VIII. Understands the psychological impact of surgical site infections and wound dehiscence
|
|
|
IX. Has an in-depth knowledge of guidelines best practice statements and care pathways related to surgical site infection
|
|
|
I. Has an advanced understanding of the principles of prevention, identification and management of surgical site infection
|
|
|
II. Ability to appropriately interpret microbiological results and diagnostic images in the context of surgical site infection and prescribe appropriate management
|
|
|
III. Applies high level clinical reasoning in all aspects of the management of patients with surgical site infected wounds.
|
|
|
IV. Contributes to the development of local referral pathways, policies and guidelines, relating to surgical site infection
|
|
|
V. Contributes to the development of relevant national guidance relating to surgical site infection
|
|
|
VI. Interprets and reports surgical site infection surveillance data in collaboration with the multidisciplinary team
|
|
|
VII. Works with stakeholders to develop and implement care pathways to prevent, report and manage surgical site infection.
|
|
|
VIII. Ensures there is local capacity to facilitate support and mentor colleagues seeking to develop their clinical practice in surgical site infection, including antimicrobial stewardship.
|
Is able to regularly and confidently assess relationships and adjust as required
| Level | Skills and Knowledge |
|---|---|
|
I. Has a fundamental knowledge of the difference between adherence, compliance and concordance in the context of patient engagement with their care
|
|
|
II. Has fundamental knowledge of a patients needs in respect of their own care
|
|
|
III. Is able to identify with the patient what their needs are and how they can be balanced against the clinical goals
|
|
|
IV. Recognises the positive impact of self-supported management to the patient, family and the health and social care sector.
|
|
|
V. Has an awareness of the various psychosocial factors influencing a patient’s engagement with care (social, emotional, financial, intellectual etc.)
|
|
|
VI. Is aware of own role in engaging and empowering the patient to make effective and timely decisions regarding their care
|
|
|
VII. Is able to identify their own needs in respect of skills and capability in patient engagement
|
|
|
I. An understanding of the difference between adherence, compliance and concordance in the context of patient engagement with their care
|
|
|
II. Works collaboratively with patients and other stakeholders to provide patient centred care and promote supported self management
|
|
|
III. Recognises the various psychosocial factors influencing a patient’s engagement with care (social, emotional, financial, intellectual etc.)
|
|
|
IV. Disseminates appropriate education and information for the patient and/or families to support self management
|
|
|
V. Is able to support the patient to agree therapeutic goals
|
|
|
VI. Able to work with the patient to identify and achieve shared goals and outcomes respecting personal beliefs
|
|
|
VII. Recognises the role of verbal and non verbal communication on relationship development (Being attentive, showing focused listening, eye contact, validating etc.) whilst attending to concerns in respect of patients ideas, discourse, feelings and attitudes.
|
|
|
I. An in depth understanding of the ethical implications of concordance and its implications for practice and accountability
|
|
|
II. Advanced knowledge of concordance and patient choice and educates and advises colleagues
|
|
|
III. Ability to confidently assess relationships and adjust as required
|
|
|
IV. Can demonstrate a facilitative, encouraging and supportive relationship with the patient and others involved in their care
|
|
|
V. Has understanding of the role of motivational interviewing in improving patients outcomes
|
|
|
VI. Ability to advise and support high level discussion when ethical decisions are debated
|
|
|
VII. Contributes to the wider discussion and strategy development in respect of concordance
|
|
|
I. Works with colleagues and patients to identify, define and refine organisational strategy for engaging patients in the development and management of their care package
|
|
|
II. Is able to use motivational interviewing techniques to help improve patient outcomes
|
|
|
III. Provides clinical leadership, supervision and expertise to colleagues in respect of understanding the implications of facilitating patient concordance
|
|
|
IV. Is able to work in partnership to create greater understanding and address patient concerns or disagreements in respect of care package.
|
|
|
V. Is able to develop appropriate metrics to monitor self-supported management
|
|
|
VI. Ability to undertake local audits to assess the impact of the service approach to self-supported management
|
|
|
VII. Is able to use Quality Improvement methodology to continue to assess/evolve service approach to self-supported management
|
|
|
VIII. Is able to produce local reports to quality forums in relation to self-supported management
|
|
|
IX. Develops Patient and Public forums and actively promotes the need for patient/public engagement as part of any service reform/quality improvement/research.
|
Practitioners should be able to provide effective care for patients with foot ulcerations and demonstrate the following competencies.
| Level | Skills and Knowledge |
|---|---|
|
I. Fundamental knowledge of the Anatomy & Physiology of the foot
|
|
|
II. Is able to provide patients advice on how to ensure pressure relief/redistribution
|
|
|
III. Encourages the patient/carer to adhere with recommended management plan
|
|
|
IV. Is able to assess condition of skin and nails on feet
|
|
|
V. Awareness of the importance of good feet/nail care
|
|
|
VI. Awareness of importance of prevention of ulceration
|
|
|
VII. Ability to apply specialist footwear/devices
|
|
|
VIII. Understands when to refer patient to other health care professionals
|
|
|
IX. Is able to report care interventions and concerns to the senior nurse and/or other health care professionals in a timely manner
|
|
|
X. Is aware of own limitations and seeks appropriate advice in a timely manner
|
|
|
XI. Is aware and works to local policies, guidelines, pathways
|
|
|
I. An understanding of the Anatomy & Physiology of the foot
|
|
|
II. Fundamental knowledge of the biomechanics of the foot
|
|
|
III. Is able to identify and use appropriate assessment tools/care pathways
|
|
|
IV. Is able to screen patients and identify ‘red flags’ according to National Wound Care Strategy Programme (NWCSP):
|
|
|
V. Recognises the importance of ‘immediate and necessary care’ as defined by the NWCSP
|
|
|
VI. Is aware of national timescale for referral and assessment and understands the impact of these in relation to patient outcomes
|
|
|
VII. Is able to identify a range of potential causes of ulceration in the foot.
|
|
|
IX. Competent at performing ABPI and toe pressure assessment
|
|
|
VIII. Able to undertake holistic assessment and develop individualised management plan/makes recommendations for further assessments.
|
|
|
X. Able to confirm to the patient and or carer understanding of the purpose and the nature of management plan
|
|
|
XI. Understanding of the principles of foot ulcer prevention strategies
|
|
|
XII. Understanding of the principles of foot ulcer management strategies
|
|
|
XIII. Able to recognise causes of foot ulceration
|
|
|
XIV. Ability to appropriately categorise pressure damage and report as appropriate
|
|
|
XV. Ability to be able to assess for peripheral neuropathy
|
|
|
XVI. Ability to assess for lower limb oedema and lymphoedema
|
|
|
XVII. Recognise benefits of oedema reduction
|
|
|
XVIII. Understanding of psychological impact of foot ulceration
|
|
|
XIX. Works collaboratively with colleagues to optimise patient concordance
|
|
|
XX. Initiates strategies to prevent recurrence of ulceration
|
|
|
XXI. Recognises need for timely onward referrals
|
|
|
XXII. Is able to access and use referral pathways as appropriate
|
|
|
XXIII. Escalates concerns when appropriate
|
|
|
XXIV. Recognises when emergency referral is required
|
|
|
I. In depth understanding of the pathophysiology of arterial disease neuropathy and diabetic foot infection.
|
|
|
II. An understanding of the biomechanics of the foot
|
|
|
III. Recognises the need for vascular assessment for all patients with foot ulceration
|
|
|
IV. Ability to assess evidence of/severity of infection e.g. collection, local, spreading’ systematic and manage/refer appropriately
|
|
|
V. Competent at performing foot pulse palpation
|
|
|
VI. Ability to accurately interpret ABPI or toe pressure results
|
|
|
VII. Ability to diagnose underlying cause of ulceration
|
|
|
VIII. Recognises other factors that could impact on patient healing
|
|
|
IX. Ability to use recognised classification tools eg: WIFI, Wager etc
|
|
|
X. Demonstrates appropriate use of referral pathways into MDT
|
|
|
XI. Ability to clearly and concisely explain to patient the underlying cause of the ulceration
|
|
|
XII. Ability to clearly and concisely explain to the patient the benefits of offloading strategies
|
|
|
XIII. Is able to recognise dermatological conditions associated with the feet e.g. callous, eczema, fungal infection
|
|
|
XIV. Ability to request imaging such as foot x-rays
|
|
|
XV. Recognises the need for and implements appropriate offloading strategies
|
|
|
XVI. Knowledge of all current options of offloading strategies
|
|
|
XVII. In depth understanding of advantages and disadvantages of all offloading strategies
|
|
|
XVIII. Able to demonstrate competency at selection and application of offloading strategies using a variety of systems
|
|
|
XIX. Understands the importance of gait/footwear assessment and impact on healing
|
|
|
XX. In-depth understanding of the psychological impact of foot ulceration
|
|
|
XXI. Uses strategies to improve patient concordance
|
|
|
XXII. Evaluates interventions to develop evidence based individualised care plans
|
|
|
XXIII. Is actively involved in education of patients and carers
|
|
|
XXIV. Aware of all options to aid prevention of recurrence
|
|
|
XXV. Understands the reasons for and encourages the need for MDT involvement to reduce time to healing and reduce risk of recurrence
|
|
|
XXVI. Teaches other staff in relation to foot ulceration management using agreed materials
|
|
|
XXVII. Knowledge of national guidance relating to foot ulceration
|
|
|
XXVIII. Is aware of and implements emerging evidence in the management of foot ulceration
|
|
|
I. Advanced knowledge of Anatomy & Physiology of foot
|
|
|
II. An advanced understanding of the biomechanics of the foot
|
|
|
III. Has advanced understanding of underlying disease process.
|
|
|
IV. Possesses advanced assessment skills and differential diagnostic skills
|
|
|
V. Able to diagnose and develop treatment plans for complex foot ulceration
|
|
|
VI. Advanced knowledge of management and treatment options for complex conditions eg infected Charcot foot ulceration
|
|
|
VII. Able to assess pulse status of femoral, popliteal and foot pulses
|
|
|
VIII. Able to interpret Doppler wave forms/doppler auscultation
|
|
|
IX. Can determine prominent factors in mixed disease ulceration eg neuroischaemic ulceration
|
|
|
X. Ability to refer directly to colleagues for investigations or treatments
|
|
|
XI. Advanced knowledge of equipment/products/modalities for treatment of foot ulceration
|
|
|
XII. Advanced knowledge of offloading/pressure redistribution strategies
|
|
|
XIII. Advanced knowledge of supportive strategies to facilitate healing (e.g. weight management, physiotherapy, orthotics, nutrition, etc.)
|
|
|
XIV. Advanced knowledge of prevention of recurrence strategies
|
|
|
XV. Develops, delivers and evaluates education and training for the multi-disciplinary team on the management and prevention of foot ulceration
|
|
|
XVI. Monitors prevalence, time to assessment and healing rates for patients with foot ulceration, benchmarks this against national standards/data
|
|
|
XVII. Ability to request imaging such as foot MRI or venous/arterial duplex scanning
|
|
|
XVIII. Ability to interpret x ray imaging findings
|
|
|
XIX. Collaborates with the MDT to establish clear referral pathways between relevant services e.g. dermatology, rheumatology, diabetic MDT & vascular surgery
|
|
|
XX. Ability to directly refer to other specialities
|
|
|
XXI. Contributes to the development of regional and national guidance
|
|
|
XXII. Develops and disseminates polices related to the management of foot ulceration based on current national and international guidelines
|
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XXIII. Works with stakeholders to develop care pathways to improve healing rates of patients with foot ulceration and prevent amputations
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XXIV. Facilitates, interprets and leads the collection of data for local and national audits
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XXV. Develops and undertakes research projects in relation to foot ulceration
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XXVI. Works with higher educational institutes to develop training/education in relation to foot ulceration
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