National best practice and evidence based guidelines for wound ...

N at i o N a l b e s t p r ac t i c e a N d e v i d e N c e b a s e d g u i d e l i N e s f o r w o u N d m a N ag e m e N t
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Appendix 2: Wound Assessment Forms from AMNCH Tallaght (continued)
Treatment Objective
Type of cleansing
solution
Treatment of
surrounding skin
Type of primary
dressing
Type of secondary
dressing
Method of securing
dressing
Type of compression
therapy
Frequency of
dressing change
Patient Education
Removal of:
Sutures / Staples
Steristrips
Signature:
Ward:
THE ADELAIDE & MEATH
HOSPITAL, DUBLIN
INCORPORATING
THE NATIONAL CHILDREN’S HOSPITAL
DATE
WOUND MANAGEMENT PROGRAMME
Only re-write if plan changes
OUTCOME:
Wound healed ■ Discharged ■ Did not continue to attend ■
Surname: ................................................................................
Forenames: .............................................................................
Address: ..................................................................................
................................................................................................
Hospital No.: ................................ D.O.B.: ..........................
Consultant: .............................................................................
DATE DATE DATE DATE
FOLLOW-UP REFERRAL:
G.P. ■ P. H.N. ■ OPD ■ A & E ■ Day Hosp. ■ Other ■
Signature: ........................................................................................................ Date: .................................................................................................................