Wound Care Today

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10 WOUND CARE TODAY 2017,Vol 4, No 1
WOUND ASSESSMENT CQUIN AT A GLANCE ›
this, NHS England has supported a
literature review and robust consensus
process for the development of
the Generic Wound Care Assessment
Minimum Data Set (Coleman et al,
2017) to underpin wound assessment
documentation and clinical practice.
A total of 24 articles were reviewed by
a panel of experts, with 68 potential
assessment items identified and
consensus agreement reached to
include 37 areas within five key
domains within the minimal data
set. The five key domains focus upon
(Coleman et al, 2017):
› General health
› Baseline information
› Wound assessment
› Wound symptoms
› Specialist referral.
This minimum data set will need
to be collected and documented for all
patients to meet wound assessment
CQUIN targets.
WILL CQUIN IMPROVE CARE?
For clinicians currently delivering best
practice wound care that includes
thorough wound assessment and
documentation, the CQUIN will
not dramatically impact on healing
rates. However, the evidence
presented by Guest et al (2015)
demonstrated discrepancies in care
and outcomes that will be improved
by implementation of CQUIN.
IMPLEMENTING WOUND
ASSESSMENT
NHS England acknowledges that
further education may be required
in relation to wound assessment if
targets are to be met. Further guidance
on competencies and education for
wound assessment and management
is currently being developed and
NHS England advise that this will be
shared when available. In the interim,
clinicians need to ensure that they have
the appropriate skills and knowledge
concerning wound assessment.
There are many existing resources
that facilitate a systematic approach
to thorough and holistic wound
assessment, which meet the criteria
set out by Coleman et al (2017),
including TIME.
SPECIFIC WOUND ASSESSMENT
The concept of wound bed
preparation (Schultz et al, 2003)
and the TIME framework (Dowsett,
2009) offer a logical and systematic
approach to the assessment and
delivery of wound care and have
been implemented widely in clinical
practice for years.
TIME was developed by an
international advisory panel as a tool
that offers a structured approach
to the key components of wound
assessment, namely:
› Tissue: non-viable or deficient
› Infection: or inflammation
› Moisture: moisture imbalance
› E dge: non-advancing
or undermined.
More recently, the Triangle of
Wound Assessment (Dowsett et al,
2015; World Union of Wound Healing
Societies [WUWHS], 2016) has been
developed, which also incorporates
key criteria for the assessment of
the wound bed, wound edge and
periwound skin.
Although different tools exist,
they all act as a framework to be
integrated into holistic wound
assessment so that it is done
thoroughly and consistently.
DOCUMENTATION
All observations, assessments,
measurements and photograph
images, management plans and
review times should be documented
clearly, signed, timed and dated. The
use of a specific wound assessment
chart which incorporates all the
aspects of the minimum data set will
support clinicians in achieving the
CQUIN for wound assessment.
CONCLUSION
In England, the CQUIN for wound
assessment will improve clinical
practice and wound outcomes where
needed. Outside of England, where
CQUIN is not implemented, it is
still timely to consider how wound
assessment is carried out and if
improvements in the process will
result in increased efficiency and cost-
savings. It is important to remember
that whether you are measured
against CQUIN targets or not, getting
wound assessment right makes a real
difference to patients and their lives.
As healthcare providers and clinicians,
we should embrace the opportunity
that CQUIN brings to enhance care
delivery to the benefit of both patients
and trusts.
REFERENCES
Coleman S, Nelson EA,Vowden P, et al
(2017) Development of a generic wound
care assessment minimum data set. J Tissue
Viability doi: 10.1016/j.jtv.2017.09.007
Department of Health (2017) The
Government’s mandate to NHS England
for 2017–18. Presented to Parliament
pursuant to Section 13A (1) of the
National Health Service Act 2006.
Available online:
government/uploads/system/uploads/
attachment_data/file/601188/NHS_
Mandate_2017-18_A.pdf
Dowsett C (2009) Use of TIME to improve
community nurses’wound care
knowledge and practice. Wounds UK 5(3):
14–21
Dowsett C, Gronemann M, Harding
K (2015) Taking wound assessment
beyond the wound edge. Wounds Int
9(1): 6–10
Guest JF, Ayoub N, McIlwraith T, et al
(2015) Health economic burden that
wounds impose on the National Health
Service in the UK. BMJ Open 5: e009283.
doi:10.1136/bmjopen-2015-009283.
Available online:
com/content/5/12/e009283
NHS England (2017) Commissioning
for Quality and Innovation (CQUIN).
Guidance for 2017–19. Available online:
uploads/2016/11/cquin-2017-19-
guidance.pdf
Schultz G, Sibbald G, FalangaV, et
al (2003) Wound bed preparation:
a systematic approach to wound
management. Wound Repair Regen 11(2):
1–28
World Union of Wound Healing Societies
(2016) Advances in wound care: the
Triangle of Wound Assessment. A position
document. Wounds International.
Available online:
files/WUWHS_TWA_FINAL_web.pdf
WCT