The Skin Care Service (SCS) is a team of specialist tissue viability nurses that have undergone additional training and development in tissue viability and lower limb care. Our aim is to improve patient outcomes in Mersey Care by promoting standardised best practice in Wound Care, regardless of aetiology. Through audit, education and research, we aim to continually update knowledge base and practice built on evidence available. The Skin Service covers all adult patients registered with a Liverpool or South Sefton GP or living within the Liverpool/South Sefton Area.
Conditions and treatment
The following resources are available to support clinicians within their practice:
Larval therapy, also called larvae therapy, uses live larvae to selectively and precisely remove devitalised tissue from a wound. Larvae secrete proteolytic enzymes which liquefy the devitalised tissue, and the Larvae then ingest the dead tissue through the net of the Biobag dressing. Larval therapy has many benefits in the wound healing process. Larvae help a wound to progress from the inflammatory phase of healing, reduce malodour, reduce infection rates and also help to eradicate biofilm.
NICE define a leg ulcer as a wound to the lower leg that has failed to heal within 2 weeks. There are several reasons why a leg ulcer may develop with over 70% of lower leg ulcers caused by venous insufficiency, 10% are attributed to arterial disease, 10% to 15% are mixed aetiology and 2% to 5% other causes such as connective tissue disorders, vasculitis or malignancy. It is estimated that approximately 1% of the population in the United Kingdom will suffer from leg ulceration at some point in their lives with the experience often impacting negatively on their quality of life. Without correct treatment, ulcers can remain unhealed for many months or sometimes years, resulting in episodes of infection, pain and immobility.
MASD consists of four distinct conditions, with slightly different aetiologies, namely: incontinence-associated dermatitis; intertriginous dermatitis; peri wound moisture-associated dermatitis and peristomal moisture-associated dermatitis. MASD occurs when moisture remains in constant contact with the body for prolonged periods of time, when it contains irritating substances, bacterial or fungal pathogens, and when moisture exposure increases friction at the skin surface.
Negative Pressure Wound Therapy (NPWT) also known as Topical Negative Pressure (TNP) or Vacuum Assisted Closure (VAC) applies either continuous or intermittent sub-atmospheric pressure to promote improved wound healing in chronic, difficult to heal wounds. It provides a closed system that protects the wound from external sources of contamination, whilst creating optimal conditions for complex wounds. NPWT is both a clinically and cost-effective treatment that can be used to provide maximum therapeutic benefits to the patient with complex needs. On the Merseycare Formulary the two NPWT systems in use are the Activac system and Avelle, and after a thorough assessment the most suitable system will be prescribed.
A pressure ulcer is localised damage to the skin and/or underlying tissue, usually over a bony prominence (or related to a medical or other device), resulting from sustained pressure (including pressure associated with shear). The damage can present as intact skin or an open ulcer and may be painful. In 2018 it was estimated that 202,000 patients were living with an unhealed pressure ulcer, with a mean annual cost of £5900 per pressure ulcer.
A wound is a disruption of the integrity and function of the tissues in the body. Any injury to the skin interrupts continuity and the protective and functional capacity, rendering the individual physically and emotionally vulnerable, therefore achieving wound healing is a priority. Failure to appropriately assess wounds leads to increased healing times, patient discomfort, increased risk of infection, inappropriate use of dressings and reduction in patient quality of life. Effective wound management requires an understanding of the physiology of wound healing, combined with an ongoing process of assessment, clinical decision making, intervention, and documentation to facilitate optimal wound healing.
- Skin tear pathway and treatment algorithm
- Moisture associated skin damage pathway
- Leg ulcer pathway/vascular pathway – coming soon
- Pressure ulcer pathway
- Chronic wound pathway
- Prevention and managing wound infection
- Infected critically colonised wound management algorithm
- General practice sepsis screening and action tool
- Critical limb ischemia pathway
- Biofilm pathway – coming soon
- Surgical Site Infection Pathway – coming soon
We have a wide range of patient information leaflets to inform and involve patients and carers in their care and improve their overall experience.
- Helping your wound to heal
- Compression hosiery therapy
- Compression bandage therapy
- Topical negative pressure and VAC therapy
- Washing and moisturising your skin
- Applying your steroids
- Expert wound and skin care
- Helping to prevent pressure ulcers
- Potassium Permanganate
- Larval debridement therapy
- Leg ulcer patient information leaflet
- Lower limb assessment and doppler
See the below for links to best practice statements
- Active treatment non healing wounds in the community
- Holistic management of venous leg ulcers
- Addressing complexities in the management of venous leg ulcers
- Antimicrobial stewardship strategies for wound management
- The use of topical antimicrobial agents in wound management
- Care of the person with diabetes and lower limb ulcers
- SSI Surveillance: Promoting a seamless patient journey from surgery to community
- Wound infection in clinical practice
- Patients presenting with ‘Red legs’: Differential diagnosis and the role of compression
- The use of compression therapy for peripheral oedema: considerations in people with heart failure
- Use of silver dressings in wound care
- Addressing skin tone bias in woundcare
- Mersey Care wound formulary – coming soon
- Mersey Care Hoisery Guide
Hoisery order forms
Patients can be referred to the SCS by their GP, community nurse or any other health care professional. Referrals should be made using the Skin Care Service Referral form and emailed to lifehouse
The Skin Care Service offer different levels of intervention, and after careful triage by one of our specialist nurses the most appropriate level of support will be offered.
- Advice given over the phone to other professionals about generic wound conditions/aetiology and wound management products but will not be patient specific. The referrer is clinically responsible for the treatment prescribed following the advice.
- Patient specific advice can be given over the phone to the referrer after careful review of the patients notes and clinical photography. The referrer is clinically responsible for the treatment prescribed following the advice.
- Joint visit with referrer, advice and education will be offered for the management of the patients care. Responsibility for monitoring of efficacy, adverse reactions, interpretation of investigations and the re-assessment of the patient treatment plan will remain with the referrer.
To support community staff to work within their role, the SCS offer Wound, Pressure Ulcer and Leg Ulcer training to help meet the core competency requirements as set out below.
- Core Competency requirements for community nurses
- Competency process for wound assessment and pressure ulcer sign off
- Learning and development prospectus
- Self-Declaration Form for Clinical Competence within the Trust
Leg Ulcer training
- Module 1 A&P
- Module 2 Assessment and ABPI
- Module 3 Treatment options and compression bandaging
- Module 4 Face to face workshop - book via the Prospectus in section 1
Please book onto your Leg Ulcer OSCE via the Prospectus in section 1 once all 4 modules complete
Wound and pressure ulcer training
- Module 1 Wounds and pressure ulcers
- Module 2 Pressure ulcer prevention and management
- Module 3 Liverpool Wheelchair Service
- Module 3 Podiatry
- Module 3 Nutrition and wound healing
- Module 3 Equipment specialist team
- Module 4 Face to face workshop - book via the Prospectus in section 1
- HCA Competencies
- Pressure Ulcer Core Curriculum Competency Framework for Intermediate Level (Registered staff)
- Pressure Ulcer Core Curriculum Competency Framework Fundamental Level (Non registered staff and Mental Health Care Division)
- Pressure Ulcer Competency Front Cover
- International Wound Infection Institute : Wound Infection Institute - International Wound Infection Institute (woundinfection-institute.com)
- The Vascular Society : Home - Vascular Society
- Wounds UK: Home Page - Wounds UK (wounds-uk.com)
- National Wound Care Strategy Programme: National Wound Care Strategy Programme | NWCSP
- The Wound Care Handbook: Wound Care Handbook | Wound Care Handbook