Tissue viability protocol

Derby and Derbyshire Safeguarding Adults Partnership
Guidance to Health and Social Care Managers in Derbyshire
Tissue Viability and Neglect: Making a decision whether to make
enquires under Safeguarding Adults policy and procedures
The purpose of this guidance is to brief managers in health and social care
a b o u t the issues to be considered when deciding whether to raise a
safeguarding referral and make enquires under the Safeguarding Adults
Policy and Procedures, in response to concerns about neglect and tissue
This guidance does not replace the need to read the Derby and Derbyshire
County Council Safeguarding Adults policy or any health guidance issued on
tissue viability.
Pressure Ulcer risk assessment
Risk assessment tools used for individuals cared for in hospitals, care homes
or their own home may differ, however, the tool used should comply with
national tissue viability guidance. The overriding principle is the effective
assessment of those people whose skin may be at risk of deterioration.
Where tissue viability is a concern and the service users live in their own
home or in a care home, they will first be seen by a carer (formal or informal)
who can refer to a GP or a District Nurse for assessment and treatment. The
health community can provide information to informal carers on how to identify
possible skin care problems.
Hospitals and private nursing homes have registered nursing staff with the
relevant skills and knowledge to assess the risk of pressure ulcer
development and manage treatment. For care homes with service users
who receive residential care, referrals are made to registered nurses working
in community nursing teams who will undertake and facilitate treatment.
Recommended Practice
Step 1
In all cases consider these three questions:
Does a safeguarding duty apply to the person?
Are there concerns that all reasonable steps have not been
taken to prevent the pressure ulcer?
Is there evidence of neglect?
1.Does a safeguarding duty apply to the person?
The safeguarding duties apply to any person who is aged 18 or over who:
Has needs for care and support (whether or not the local authority is
meeting any of those needs AND
Is experiencing, or at risk of, abuse or neglect AND
As a result of those care and support needs is unable to protect
themselves from either the risk of, or the experience of abuse or neglect.
Local Authority statutory adult safeguarding duties apply equally to those
adults with care and support needs regardless of whether those needs are
being met, regardless of whether the adult lacks mental capacity or not,
and regardless of setting, other than persons or approved premises.
Derbyshire County Council Safeguarding Adults policy
Are there concerns that all reasonable steps have not been taken to
prevent the pressure ulcer?
Where health or social care staff identify or receive concerns they must
ensure that an assessment of the individual and their care takes place by an
appropriate health care professional: doctor, registered nurse or tissue
viability specialist.
The health care professional undertaking the assessment should consider
the patient’s care plan, care delivery and relevant local / national guidance
and where necessary seek a second opinion or specialist tissue viability
Is there evidence of neglect?
Not all pressure ulcers in an adult with care and support needs are the
result of neglect.
Neglect and acts of omission – including ignoring medical, emotional or
physical care needs, failure to provide access to appropriate health, care
and support or educational services, the withholding of the necessities of
life, such as medication, adequate nutrition and heating
The key questions to ask of an appropriate nurse or doctor (from whom
you are gathering information) that apply to all settings are:
Should the illness, behaviour or disability of the adult have
reasonably required the monitoring of skin condition?
If monitoring was refused by the adult/family was it reasonable
for advice to be sought? The adult’s consent to monitoring
should always be sought but if the person lacks mental capacity
to make a decision, a decision will need to be taken in their best
interests. The family has no right to refuse monitoring.
If monitoring was agreed, was the frequency of
monitoring appropriate for the condition as presented
at the time?
Would monitoring have shown changes in the skin (e.g. changes
in colour, temperature, appearance) that should have triggered
the need for intervention or seeking expert assistance?
Was the appropriate expert assistance sought? If so did that
result in a care plan/equipment provision appropriate to address
the pressure care needs? Did the care plan address the
management of risks that should have reasonably been
identified (e.g. the high risk of non-compliance by the service
user or informal carer)?
Was the care plan adhered to and revised appropriately? Was
the equipment provided in a timely manner and used
Where a safeguarding duty applies and there are concerns that all reasonable
steps have not been taken to prevent the pressure ulcer and there is evidence
of neglect, a safeguarding report should be made.
Ref: Safeguarding Adults Policy and Procedures
Step 2
A report has been made under the Safeguarding Adults Policy and
Procedures 2015 and where it is necessary to hold a Section 42 enquiry
and next steps meeting to develop a safety plan:
The enquiry and development of a safety plan must include all agencies
agreeing their respective roles and responsibilities. This must be clearly
documented and recorded.
Where the abuse/neglect of an adult is alleged to have taken place in Derby
or Derbyshire, the report will be made to the officer in the Local Authority.
If the alleged abuse/neglect is discovered or suspected it needs to be made
clear that such information may need to be shared with other agencies on a
“need to know” basis. The service user’s consent to the sharing of
information should always be sought. In certain circumstances information
about a person may be disclosed without their consent. For further guidance
on this please refer to Derby and Derbyshire Safeguarding Adults Policy and
Procedures 2015.
Where no officer can be quickly identified then contact will be made to the
Local Authority by telephoning Call Derbyshire on 01629 533109 or Derby
Care Line on 01332 640777.
Step 3
Timescales will be set and agreed as per the Derby and Derbyshire
Safeguarding Adults Policy and Procedures. All agencies should understand
their roles and responsibilities which should be recorded and minuted at each
stage of the procedure.
Step 4
The service user’s case to be reviewed at set out in the safety plan.
National Institute for Health and Clinical Excellence Guidance for the
Prevention and Treatment of Pressure Ulcers CG 179 April 2014
Waterlow Manual pressure ulcer risk assessment/prevention 2005
March 2015