Tissue Viability: An Expensive Commodity or a Vital Role for Patient Safety?

The misunderstood specialism

Rebecca Laurie, TVSN

In the modern NHS where finances are ever stretched and overspend is a reality rather than a potential concern, looking at value in services becomes an essential part of service reviews.

Tissue Viability specialist teams nationally are often an overlooked service, with the misconception of "it's just an expensive dressing service", and it is often considered that District Nurses, Ward Managers and Practice Nurses can encompass the TVN role into their current position. The true value and potential of the service is frequently not acknowledged, as the specialism is so often misunderstood.

Expert clinical care

Tissue Viability Nurse assessments are so much more than an assessment to decide on dressings, as the dressing is often the final piece in the puzzle. TVNs have developed specific additional knowledge and skills, often to master's level, and frequently have decades of advanced clinical practice. These skills are put to use clinically on a daily basis whilst keeping abreast of new knowledge and advancements to keep policy, guidance and best practice up to date.

The role involves assessing and managing complex, chronic and non-healing wounds, and providing valued support for caseload holders using evidence-based expert knowledge in Tissue Viability.

Each patient contact takes place usually with a registered nurse who is the caseload holder for the care, providing a valuable opportunity for ad hoc teaching. The TVN completes a holistic assessment which includes a review of the medical history, medication, all appropriate risk assessments and wound assessments. Liaison with other specialists involved is often an essential part of the assessment, alongside listening to the patient to find the potential blockers for delayed healing. Finally, a robust holistic mutually agreed plan will be formulated.

Prevention strategies

The part of the role that is often hidden is the management of prevention strategies, specifically the setting and updating of Tissue Viability related policies and procedures, and ensuring these are in line with national and local guidance.

This includes leading on the implementation of both national and local initiatives to prevent and reduce pressure damage, antimicrobial stewardship within wound care, and supporting patient safety. It also includes writing and amending policy to align with national guidance, which given the breadth of knowledge of the team are evidence based, and development with the S1 design team of electronic platforms for recording Tissue Viability data.

Through review of incident reports and general observations, the Tissue Viability team are often the eyes and ears in identifying when care falls below what is expected of a responsible body of nurses. The TV team works closely and collaboratively with multiple services and trusts to support and share knowledge, helping to raise standards to an acceptable level and aiming to keep the patient safe, reducing harm and further reducing the overall long-term potential financial burden to the trust.

Education and training for multidisciplines

With the aim of achieving a sustained high standard of care, Tissue Viability teams usually deliver all training in relation to wound care. This is often considered an essential requirement, as they are the ones with the breadth of knowledge to share. The training is delivered using the most up to date research and advances in the subject area, and anecdotal evidence is often discussed.

This covers the designing, updating and delivery of an evidence-based education platform, including face to face group and 1:1 sessions, MS Teams, e-learning, and the production of reference material such as handbooks, posters and videos. Core training includes Pressure Ulcer Prevention, Lower Limb Management, Wound Management and Advanced Therapies.

Communication and multidisciplinary liaison

Multidisciplinary liaison is a key aspect of a Tissue Viability Nurse's role in keeping patients safe. Through daily liaison, using breadth of knowledge and experience to advocate for the patient and for teams, the multidisciplinary team can be supported to ensure the care required is provided or expedited as appropriate.

Legal responsibilities

Tissue Viability and litigation are closely aligned. The role of the Tissue Viability Expert Witness is to use their developed breadth of knowledge and experience to support the courts in identifying whether care fell below the standard of a responsible body of nurses. Where litigation cases involve wounds, the value of a Tissue Viability expert witness is essential for an in-depth, conscientious report.

This includes providing non-biased, evidence-based statements and verbal accounts to coroners' courts and as an expert witness to civil courts. The evidence provided is always a true representation of the findings and the care provided, is compiled following a thorough examination of the facts, and is always balanced against an acceptable standard of care. The role also extends to safeguarding, including involvement in complex safeguarding concerns within patient care and teams.

The Tissue Viability role is vital for upholding patient safety.

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