Skin Integrity

Are comprehensive, validated skin integrity risk assessments (e.g., Waterlow, Braden, or PURST) completed and regularly reviewed for at-risk individuals?

What we look for: Sample 3-5 files of people with limited mobility. Good looks like a validated tool used correctly, scored accurately, and reviewed monthly or upon change in condition. A fail is an outdated, missing, or incorrectly calculated assessment.

Evidence: Risk assessments, Initial assessments, Care plan reviews

Are topical medicines and barrier creams applied according to instructions and recorded accurately on topical MAR (TMAR) charts?

What we look for: Check TMARs and body maps. Good looks like staff signing TMARs correctly and following body maps that indicate where creams should be applied. A fail is missing TMARs or using prescribed creams for general moisturising without instruction.

Evidence: TMAR charts, MAR charts, Body maps

Have care staff received adequate and up-to-date training on pressure ulcer prevention and tissue viability?

What we look for: Check the training matrix. Good looks like specific tissue viability/pressure area care training is mandated and in date for all staff supporting high-risk people. A fail is relying solely on basic manual handling training.

Evidence: Training matrix, Training certificates, Supervision records

Are care workers checking that pressure-relieving equipment (e.g., air mattresses, cushions) is set correctly and functioning?

What we look for: Look for evidence that staff check mattress settings (e.g., matching the person's weight) during visits. Good looks like documented checks of equipment settings. A fail is no awareness or recording of equipment functioning.

Evidence: Daily notes, Equipment check logs, Care plans

Is there clear evidence in daily logs and repositioning charts that repositioning and skin checks are completed as prescribed?

What we look for: Review daily logs for consistency. Good looks like repositioning recorded at exact prescribed intervals with notes on skin condition. A fail is gaps in recording or simply writing 'turned' without specifying position or skin checks.

Evidence: Daily care notes, Repositioning charts, Fluid/turn charts

Are pressure damage incidents (Grade 2 and above) escalated appropriately, including CQC notifications and safeguarding alerts?

What we look for: Review incident logs for pressure ulcers. Good looks like local authority safeguarding protocols followed and CQC notified of serious injuries. A fail is failing to recognize a severe pressure ulcer as a potential safeguarding issue.

Evidence: Incident reports, Safeguarding logs, CQC notification records

Is there evidence of timely referrals and effective joint working with District Nurses or Tissue Viability Nurses when skin deteriorates?

What we look for: Trace the timeline from when red skin/damage was first noted to professional referral. Good looks like immediate escalation and clear documentation of advice given by DNs/TVNs. A fail is delayed reporting or care workers attempting to treat wounds themselves.

Evidence: Communication logs, MDT notes, Referral forms, Daily notes

Is there a clear link identified and managed between nutrition/hydration risks (MUST scores) and skin integrity?

What we look for: Check files of people with skin breakdown. Good looks like fluid/diet intake is heavily monitored to support wound healing. A fail is treating skin integrity in isolation without addressing poor nutritional intake.

Evidence: MUST assessments, Fluid charts, Food charts, Nutritional care plans

Do care plans contain specific, personalized guidance for preventing pressure damage and managing skin integrity?

What we look for: Check if care plans detail repositioning frequencies, specific areas of risk, and instructions for barrier creams. Good looks like clear, actionable steps for care workers. A fail is generic 'check skin' instructions without specific detail.

Evidence: Care plans, Skin integrity protocols, Mobility care plans

Does management systematically review skin integrity incidents to identify trends and implement service-wide preventative measures?

What we look for: Review management meetings or quality reports. Good looks like a manager spotting a trend in missed cream applications and running targeted toolbox talks. A fail is treating every skin tear or pressure sore as an isolated event with no wider learning.

Evidence: Quality assurance reports, Audit reports, Incident trend analysis, Meeting minutes