12 Is there documented evidence that the None condition of the surrounding skin has been recorded? CRITERION EXCEPTION COMPLIANCE ACHIEVED YES NO N/A 13 Is there documented evidence that the % None tissue type in the wound bed has been assessed? 14 Is there documented evidence that the None patient and the wound have been assessed for clinical signs of infection? If there is documented evidence that clinical signs of infection are present please also complete infected wound audit tool. Communication 15 Is there documented evidence that the None risks, benefits and alternative treatments have been discussed with the patient? 16 Is there documented evidence that None consent to treatment has been obtained? Care Planning and Evaluation Is there documented evidence that the None 17 wound management plan (e.g. wound dressing selection) has been recorded 18 Was the wound dressing used in line with Clinical rationale LCH formulary? * provided for non formulary prescribing* *Identify which non formulary products where used.(if applicable) 19 Did the wound dressing selection appear None appropriate for the clinical characteristics of the wound? if NO provide details below* * Is there documented evidence that a 20 Where only one visit was wound care plan has been recorded with required review date identified? 21 Did the frequency of dressing change Where only appear sufficient for clinical need? one visit was required 22 Is there documented evidence that the Where only one visit expected result of wound care plan (eg was wound debridement / granulation etc) has required been identified? 23 Is there documented evidence that the Where only one visit wound care plan has been reviewed at was identified review dates? required
12 Is there documented evidence that the condition of the surrounding skin has been recorded? None CRITERION EXCEPTION COMPLIANCE ACHIEVED YES NO N/A 13 Is there documented evidence that the % tissue type in the wound bed has been assessed? None 14 Is there documented evidence that the patient and the wound have been assessed for clinical signs of infection? None If there is documented evidence that clinical signs of infection are present please also complete infected wound audit tool. Communication 15 Is there documented evidence that the risks, benefits and alternative treatments have been discussed with the patient? None 16 Is there documented evidence that consent to treatment has been obtained? None Care Planning and Evaluation 17 Is there documented evidence that the wound management plan (e.g. wound dressing selection) has been recorded None 18 Was the wound dressing used in line with LCH formulary? * Clinical rationale provided for non formulary prescribing* *Identify which non formulary products where used.(if applicable) 19 Did the wound dressing selection appear appropriate for the clinical characteristics of the wound? if NO provide details below* None * 20 Is there documented evidence that a wound care plan has been recorded with review date identified? Where only one visit was required 21 Did the frequency of dressing change appear sufficient for clinical need? Where only one visit was required 22 Is there documented evidence that the expected result of wound care plan (eg wound debridement / granulation etc) has been identified? Where only one visit was required 23 Is there documented evidence that the wound care plan has been reviewed at identified review dates? Where only one visit was required