Creating connections: a new referral pathway for tissue viability nursing in care homes through quality improvement

Chronic wounds are highly prevalent among older adults in care homes and place significant demands on healthcare systems. This article reports on the design, implementation and early impact of a new tissue viability nursing referral pathway for care homes in NHS Lothian, developed through quality improvement methodologies.

The initiative aimed to increase direct access for registered nurses in care homes to specialist tissue viability nursing advice via a secure e-clinic referral process, supported by training, standardised equipment and a bespoke data tracker.

Using the model for improvement and plan-do-study-act cycles, a collaborative team developed a governance-compliant process that included the provision of secure email, wound cameras and structured guidance.

Following pathway implementation in February 2024, annual referral rates from care homes rose from under 150 to approximately 280, suggesting a previously unmet need for tissue viability nursing support. Most referrals were for pressure ulcers and venous leg ulcers, reflecting previously known wound burdens in long-term care. Evaluation data also suggested a potential reduction of 262 district nursing visits in the first year, with care home staff reporting improved responsiveness, confidence and resident outcomes. Challenges included digital infrastructure compatibility and ongoing staff support.

The project demonstrates how collaborative quality improvement approaches can enhance community wound care, improve integration between health and social care sectors, and optimise use of specialist nursing resources. With an ageing population and increasing wound complexity in care homes, such models offer scalable solutions to address workforce pressures and improve equitable access to tissue viability expertise.