(NPWT) including Vacuum Assisted Closure (Vac) - Royal United ...

Negative Pressure Wound Therapy 

(NPWT) including Vacuum Assisted 

Closure (Vac) in adults 

Reference Number: 745 

Author & Title: 

Responsible Director: 

Kate Purser, Senior Nurse for Tissue Viability 

and Nicola Heywood, Tissue Viability Nurse 

Specialist 

Director of Nursing 

Review Date: 6 June 2016 

Ratified by: 

Mary Lewis 

Acting Director of Nursing 

Date Ratified: 6 June 2013 

Version: 2 

Related Policies & Guidelines: 

Management of Infected and MRSA wounds 

Document name: Negative Pressure Wound Therapy (NPWT) Ref.: 745 

Issue date: 10 June 2013 

Status: Approved 

Author: Kate Purser and Nicola Heywood Page 1 of 20

Index: 

1. Policy Summary _______________________________________________ 4 

2. Policy Statements _____________________________________________ 4 

3. Definition of Terms Used _______________________________________ 5 

4. Duties and Responsibilities _____________________________________ 5 

4.1 Tissue Viability Nurse (TVN) ________________________________________ 5 

4.2 Ward/Department Staff ____________________________________________ 6 

4.3 Ward/Department Managers ________________________________________ 6 

5. How does NPWT work __________________________________________ 7 

6. Assessing patients for NPWT ____________________________________ 7 

7. Indications for NPWT ___________________________________________ 8 

8. Contraindications for NPWT _____________________________________ 8 

9. Wounds which may be treated with NPWT with precautions __________ 9 

10. Patients with open abdomens __________________________________ 10 

11. Consent ____________________________________________________ 10 

12. Potential complications ________________________________________ 11 

13. When to discontinue NPWT ____________________________________ 12 

14. User responsibilities __________________________________________ 12 

15. Education / Competency _______________________________________ 13 

16. Discharge ___________________________________________________ 14 

17. Who to contact for further help/information _______________________ 15 

18. Monitoring Compliance ________________________________________ 15 

19. Review _____________________________________________________ 15 

20. References __________________________________________________ 16 

Document Control Information ______________________________________ 18 

Ratification Assurance Statement _____________________________________ 18 

Consultation Schedule _______________________________________________ 19 

Equality Impact: (A) Assessment Screening ____________________________ 20 





Amendment History 

Issue Status Date Reason for Change Authorised 

1 Approved March 

2009 

New Policy 

Clinical 

Governance 

2 Approved 6 June 

2013 

1. Planned Review 

2. Expanded scope. Previously 

“Vacuum Assisted Closure 

(VAC)” changed to: “(VAC) 

Therapy included in the 

Negative Pressure Wound 

Therapy (NPWT) including 

Vacuum Assisted Closure 

(Vac)” 

Committee 

Mary Lewis 

Acting Director of 

Nursing 





1. Policy Summary 

• The purpose of this policy is to provide guidance for staff within the Royal United 

Hospital (RUH), Bath NHS Trust about the requirements and processes for 

NPWT. 

• NPWT involves the use of a medical device to obtain negative pressure or a 

vacuum within a wound via a foam or gauze interface to promote healing. Both 

the suction effect and the mechanical forces generated in the wound lead can 

positively influence the wound healing process. 

• NPWT also assists in the removal of excess exudate thereby reducing local 

oedema. As such, NPWT can improve wound healing and health related quality 

of life. 

• The RUH currently uses Vacuum Assisted Closure (V.A.C.®) to deliver NPWT. 

2. Policy Statements 

• The use of NPWT should be guided by informed clinical judgment and only 

commenced following a full assessment by a practitioner who has completed 

RUH NPWT training and completed self-assessment competencies following 

supervision by an experienced colleague. 

• This policy will identify what types of wounds are suitable for NPWT, who can 

use the therapy and how it is to be managed. 

• This policy aims to ensure the safe and effective use of NPWT in the RUH. 

• This policy also aims to ensure that no act or omission on the part of clinical 

professionals leads to the inappropriate management of a patient’s wound 

(Nursing and Midwifery Council (NMC), 2008). 





3. Definition of Terms Used 

NPWT: is a generic term used to describe vacuum assisted therapy that is not 

associated with any particular brand/company. 

Vacuum assisted closure (V.A.C.®) therapy: is one of the most established 

negative pressure systems and uses a vacuum to create continuous or 

intermittent negative pressure at the wound bed to remove fluid, exudate and 

infectious materials as well as stimulating perfusion and new tissue growth 

(World Union Wound Healing Society, 2008). 

4. Duties and Responsibilities 

This policy applies to all members of staff involved in any aspect of NPWT. They 

have responsibility for ensuring that the principles outlined within this document 

are universally applied. The responsibility for the delivery of care of the patient 

remains with trust staff and the nurse in charge of ward 

4.1 Tissue Viability Nurse (TVN) 

• The TVN will assist ward staff to assess and manage patients with 

complex wounds requiring NPWT. 

• The TVN will ensure that regular training is available for appropriate 

staff. The NPWT training will be regularly reviewed to ensure that it is 

current. Registered nurses have a responsibility to ensure that their 

knowledge and skills are up to date, in order to maintain and develop 

their competence (NMC, 2008). 

• The TVN will ensure that self-assessment competencies are available 

for those who have undertaken NPWT training. 





4.2 Ward/Department Staff 

• Will at all times follow the Trust procedure for NPWT. 

• Must complete a comprehensive wound assessment which will be 

documented on the Trust wound assessment form. 

• Following assessment, ward/department staff will refer the patient to 

the TVN if required. 

• The patient’s suitability for NPWT will be assessed by either the TVN 

or a trained registered nurse who has completed the full RUH NPWT 

training and competencies. Please note that although the term 

registered nurse is used throughout this document it is acknowledged 

that other registered allied health professionals may undertake NPWT 

after appropriate training. For further clarification, please contact the 

TVN. This assessment will be clearly and accurately documented in 

the patient’s medical notes by the registered nurse (NMC, 2009). 

• The nurse undertaking NPWT will ensure that a photograph is taken 

of the wound (with patient consent) prior to and after NPWT. 

• The nurse undertaking NPWT will gain informed consent prior to 

commencement of the therapy and this will be documented in the 

Medical Notes. Patients will be advised of the potential benefits and 

complications and a patient information leaflet given to them and fully 

explained (NMC, 2008). 

• The nurse undertaking NPWT will ensure that the RUH NPWT 

assessment and Care Plan is fully completed. 

4.3 Ward/Department Managers 

• Ward managers are responsible for ensuring that there is adherence 

with the policy by their staff. 

• Ward managers will ensure that they have adequate numbers of staff 

who have completed NPWT training. This includes full NPWT 

training including the completion of competencies and the shorter 

ward based training on the management of NPWT devices for those 





managing patients with NPWT, but not undertaking assessments or 

dressing changes. 

5. How does NPWT work 

The following are suggested mechanisms of action: 

• Change in microvascular blood flow improving local perfusion 

• Removal of fluid exudate and reduction of oedema 

• Stimulation of the formation of granulation tissue 

• Reduction in bacterial colonisation 

• Mechanical closure of wound by reverse tissue expansion 

• Maintenance of a moist wound healing environment (Kinetic Concepts inc. 

(KCI), 2007). 

6. Assessing patients for NPWT 

NPWT may only be used following a formal NPWT SBAR assessment (see Tissue 

Viability intranet site for latest assessment documents) by a competent registered 

nurse who has completed RUH NPWT training and competencies, a TVN or the 

patient’s medical registrar or consultant. 

The rationale for NPWT must be clearly documented in the patient’s medical notes. 

All patients receiving NPWT will have a NPWT SBAR care-plan commenced (see 

Tissue Viability Intranet site for documents) 

There are no NPWT systems that are cleared for use in newborns, infants or 

children. This policy only applies to adults (Food and Drug Administration (FDA), 

2011). 





7. Indications for NPWT 

• Wounds free from slough or eschar (KCI, 2007) 

• Acute and traumatic wounds (KCI, 2007) 

• Venous or diabetic ulcers (Xie et al. 2010; Armstrong et al. 2002; Philbeck et al. 

2001). 

• Grade 3 or 4 pressure ulcers (Xie et al. 2010; Baynham et al. 1999) 

• Dehisced surgical wounds (KCI, 2007) 

• Flaps and skin grafts (Scherer et al. 2002; Lee et al. 2011) 

• Full-thickness debrided wounds (KCI, 2007) 

8. Contraindications for NPWT 

Standard NPWT should not be used for any of the following wounds: 

• Non enteric or unexplored fistulas 

• Open abdomens 

• Cavity / sinus of unknown depth or origin 

• Wound with local malignancy 

• Necrotic tissue/eschar 

• Untreated osteomyelitis 

• Actively bleeding wounds 

• Wounds with exposed blood vessels, nerves, structures or organs 

• Vascular anastomosis & exposed anastomotic sites 

• The patient is unable to understand what the therapy entails, or comply with 

treatment (refer to Mental Capacity Act (Department of Health, 2005), sections 2, 

3 and 4) 

• The patient has capacity and declines NPWT, ensure this is fully documented 

and discussed with the consultant, TVN and ward manager. 





9. Wounds which may be treated with NPWT with 

precautions 

For the following wounds, NPWT may only be used in consultation with the TVN 

and/or the patient’s consultant: 

• Wounds with unstable fractures, open joints or sharp / loose fragments of bone. 

• Enteric fistulae of known origin for closure (Alvarez et al. 2001). 

• Wounds with exposed tendon (Heugel et al. 2002). 

• Infected wounds – daily dressings may be required in conjunction with 

antimicrobial wound liners and treatment with systemic antibiotics if appropriate. 

• Patients who are taking anti-coagulants, have haemostasis problems or a friable 

wound – seek specialist TVN advice and line the wound with a non-adherent 

dressing prior to application of the foam. Paraffin tulle should never be used. The 

patient’s clotting times must be monitored closely during NPWT and lower 

pressures may be required. 

• Wound near organs or irradiated, sutured or weakened blood vessels – seek 

specialist TVN advice and protect these with at least 3 layers of a non-adherent 

dressing and consider using lower pressures. 

• Chronic wounds – NPWT should only be considered after an appropriate wound 

management plan including modern wound dressings has failed (Azad & 

Nishikawa, 2002; Joseph et al. 2000). 

Discuss any queries with the TVN or the appropriate company prior to application of 

NPWT. 





10. Patients with open abdomens 

• The open abdomen is a technique also known as laparostomy, in which the 

fascia is left open intentionally to avoid elevation of intra-abdominal pressure and 

where surgical re-exploration is desirable. Temporary abdominal closure can be 

achieved using a dressing or technology intended to protect the exposed viscera 

(KCI, 2009; Garner, 2001). 

• The abdominal dressing NPWT system can assist to stabilise the abdominal 

wall, quantify and collect exudate, protect the intra-abdominal viscera and keeps 

the fascia intact and the cutaneous plane for subsequent closure (Caro et al. 

2011). 

• Patients with open abdomens must be referred to the TVN via Millennium within 

24 hours for consideration of specialized NPWT pumps & dressings designed 

specifically for the open abdomen. 

• Ward staff will not perform NPWT assessments or apply NPWT to the open 

abdomen, this must be managed by the patients’ consultant with appropriate 

involvement of the TVNs. Each patient will be managed individually (KCI, 2009). 

• All patients with NPWT insitu over an open abdomen who are well enough to 

mobilise should be assessed for corsetry and mobilized cautiously. This is to 

ensure that the NPWT seal is maintained. 

• For further information on the open abdomen and NPWT, please refer to the 

‘Clinical guidelines for the management of the open abdomen with KCI systems 

for active abdominal therapy’ (KCI, 2009) (See Tissue Viability intranet site). 

11. Consent 

• Verbal consent must be gained from the patient and this will be documented in 

the patient’s medical notes. 

• A patient information leaflet should be given and discussed with all appropriate 

patients and carers and is available on the Tissue Viability intranet. Patients 

MUST be monitored for any signs of bleeding and be educated on the 

importance of seeking assistance promptly in the case of haemorrhage (FDA, 

2009; 2011). 





12. Potential complications 

Rarely, complications may occur which require that the therapy is discontinued. 

These include: 

• Pressure necrosis from the tubing 

• Trauma of peri-wound skin 

• Growth of granulation tissue into foam - this may be avoided by using the white 

foam dressings (Versafoam) or by lining the wound with a non-adherent dressing 

• Allergic reaction to the drape 

• Fistula formation 

• Neoplasm caused by an increase in blood flow and rate of healing 

• Retained foam in wound, practitioners should always ensure that they have 

removed all foam pieces from the wound 

NPWT may also need to be discontinued if the patient experiences: 

• Psychological intolerance / non–concordance with NPWT 

• No healing response within one week of commencing NPWT 

• Frank pus in the dressing or canister 

NPWT will need to be discontinued immediately if the patient experiences: 

• Uncontrolled / excessive bleeding or haematoma under the dressing 

• Excessive pain: Patients may complain of mild increased pain when NPWT is 

initially commenced. This is usually due to the vacuum effect as the foam or 

gauze collapses and should settle down soon after application (Krasner, 2002). 

Pain may also be caused by high pressures, so consider reducing the pressure 

setting. The use of white Versafoam or non-adherent dressings under NPWT 

black foam (Granufoam) may also help reduce pain. However, if the pain is 

continuous or severe then discontinue the therapy (Fraccalvieri et al. 2011). 





13. When to discontinue NPWT 

• NPWT is associated with a significant cost implication, therefore there should be 

regular reassessments of the need to continue NPWT. Reviews should be 

undertaken by registered nurses with RUH NPWT competencies & occur at least 

weekly. The TVN can be contacted for advice and or assistance with 

reassessments. 

• NPWT should be only be discontinued in discussion with the TVN or the patients’ 

medical team. However, if there is a serious problem such as 

excessive/uncontrolled bleeding or pain, stop the therapy immediately. 

• Discontinue NPWT therapy if it no longer appears to be effective and the wound 

has become ‘static’ i.e. there is no new granulation tissue after one week. 

Discuss with TVN whether NPWT should be continued. 

• Exudate levels are so low that the wound is drying out. 

• The wound has reached a stage at which NPWT therapy is no longer required i.e. 

has granulated up to the level of the surrounding skin. 

• The patient is unable to be discharged / transferred with NPWT therapy. 

14. User responsibilities 

It is the responsibility of the clinical staff that use NPWT to: 

• Refer all patients on NPWT to the Tissue Viability team through Millennium. 

• Only use NPWT once they have received approved RUH NPWT training and 

completed the NPWT competencies. 

• Be familiar with RUH policies and protocols, relevant company information and 

instructions, prior to using the therapy (see Tissue Viability intranet for the latest 

resources). 

• Ensure that the NPWT policy and all relevant literature are available for all 

members of the multidisciplinary team responsible for the patient. 





• Ensure that the consumables used are those recommended by the company and 

are compatible with the machine. 

• Obtain the consumables required for the therapy and where areas regularly use 

NPWT, to ensure that an adequate supply of these is maintained. 

• Ensure that Infection Control and user safety measures are adhered to with 

reference to manufacturing instructions and RUH infection control policy. 

• Ensure that the Medical Equipment Library (if the pump is RUH owned) or the 

relevant company (if a rental pump is used) is informed of any patient transfers. 

• Accept the cost of the therapy when it is being used in their area. 

15. Education / Competency 

Staff may only use NPWT following attendance at an RUH NPWT workshop 

completion of the NPWT self-assessment competency framework. 

and 

There are three levels of NPWT competency: 

• Novice practitioner: Has the ability to renew an existing NPWT dressing safely. 

This level may be undertaken by registered nurses, NVQ 3’s and student nurses. 

NVQ 3’s and student nurses must complete their competencies with the TVNs. 

Registered nurses may complete their competencies with a registered nurse in 

their area who has already gained the ‘experienced’ competencies. 

• Competent practitioner: Has the ability to initiate and manage NPWT on a patient 

within their own clinical specialty. This level may be undertaken by appropriate 

registered staff. 

• Experienced practitioner: Is able to assess a patient’s suitability for NPWT and 

can initiate and manage NPWT in a variety of clinical situations. This level can 

be undertaken by Band 6 and above registered staff. They will assess ‘Novice’ 

and ‘Competent’ staff. It is recommended that all areas using NPWT therapy 

have at least one ‘Experienced’ practitioner. Competency at this level can only 

be assessed by the TVN. 





16. Discharge 

A patient may only be discharged home with a NPWT pump following discussion 

with the patient’s consultant and/or the TVN. 

The team responsible for the patient will ensure that prior to discharge: 

• Agreement is obtained from the relevant GP / community nursing team that 

they will assume responsibility for the NPWT. Ward staff should contact the 

community teams with plenty of notice if a discharge is imminent. At least 48 

hours’ notice is usually required. 

• The RUH TVN is contacted with the following details: 

o Type of unit in use including rental number 

o Type of dressing in use 

o Expected discharge date 

o Type of wound 

o Any relevant medical/surgical history 

• The TVN will contact the relevant community tissue viability team to agree 

funding the therapy. 

• Patients will not be discharged with RUH owned pumps. Those patients with a 

trust owned pump will be allocated a rental pump. 

• The relevant company is informed on the day of discharge, in order to cancel / 

transfer the rental agreement. 

• The patient is discharged home with enough consumables to enable two 

complete changes of NPWT dressings. 





17. Who to contact for further help/information 

• Tissue Viability Nurse: Ext. 1112/1837 or page through switchboard 

• KCI helpline (24 hours – 0800 980 8880) 

• Tissue Viability intranet site: http://webserver.ruhbath.swest.nhs.uk/clinical_directory/clinical_depts/tissue_viability/index.asp 

menu_id=10 

18. Monitoring Compliance 

The Tissue Viability service will review any incidents of non-concordance with this policy. 

Key themes of any non-concordance will be reported to Divisional Governance 

Meetings. Ward managers have a responsibility to ensure that all staff under their 

supervision are concordant with this policy. RUH employees have a responsibility to 

ensure that they follow RUH policies and protocols in order that their care is based on 

the best available evidence and, as such, risks are minimised. 

19. Review 

This policy will be in effect for three years, unless otherwise stated. Prior to the third 

anniversary of the policy the author will be asked to review it and make any 

necessary changes prior to further ratification. 





20. References 

• Alvarez, A.A. et al. (2001). Case report vacuum-assisted closure for cutaneous 

gastrointestinal fistula management. Gynaecologic Oncology, 80, pp. 413-16. 

• Armstrong, D.G. et al. (2002). Outcomes of sub-atmospheric pressure dressing 

therapy on wounds of the diabetic foot. Ostomy Wound Management, 48(4), 

pp.64-68. 

• Azad, S. & Nishikawa H. (2002). Topical negative pressure may help chronic 

wound healing. BMJ, 324, pp.1100. 

• Baynham, S. A. et al. (1999). Treating stage IV pressure ulcers with negative 

pressure therapy: A case report. Ostomy/Wound Management 45 (4), pp. 28-35. 

• Caro, A. et al. 2011. Treatment of the open abdomen with topical negative 

pressure therapy: a retrospective study of 46 cases. International Wound 

Journal 8 (3), pp. 274-9. 

• Department of Health, 2005. Mental Capacity Act. London: Department of 

Health. 

• FDA (2011). FDA safety communication: Update on serious complications 

associated with negative pressure wound therapy systems [Online]. Available 

at: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm244211.htm 

[Accessed 16 Nov. 2012] 

• FDA (2009). Preliminary public health notification: Serious complications 

associated with negative pressure wound therapy systems [Online]. Available at: 

http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PublicHealthNotificat 

ions/ucm190658.htm[Accessed 16 Nov 2012]. 

• Fraccalvieri, M. et al. 2011. Patients pain feedback using negative pressure 

wound therapy with foam and gauze. International Wound Journal 8 (5), pp. 492- 

9. 

• Garner, G. B. (2001). Vacuum-assisted wound closure provides early fascial reapproximation 

in trauma patients with open abdomens. The American Journal of 

Surgery, 182 pp.630-638 

• Heugel, J.R. et al. (2002). Treatment of the exposed Achilles tendon using 

negative pressure wound therapy: a case report. Journal of Burn Care & 

Rehabilitation, 23 (3), pp. 167-71. 

• Joseph, E. et al. (2000). A prospective, randomised trial of vacuum-assisted 

closure versus standard therapy of chronic non-healing wounds. Wounds, 12(2): 

60-7. 

• KCI (2009). Clinical Guidelines for the Management of the Open Abdomen with 

KCI Systems for Active Abdominal Therapy. London: MEP. 

• KCI (2007). V.A.C. ® Therapy Clinical guidelines. London: MEP. 

• Krasner, D.L. (2002). Managing wound pain in patients with vacuum-assisted 

closure devices. Ostomy Wound Management, 48 (5) pp.38-43. 





• Lee, D. L. et al. 2011. Negative Pressure Wound Therapy: An adjuvant to 

surgical reconstruction of large or difficult skin and soft tissue defects. 

International Wound Journal 8 (4), pp. 406-11. 

• Philbeck, T. E. et al. (2001). Vacuum-assisted closure therapy for diabetic foot 

ulcers: clinical and cost analyses. Home Health Care Consultant, 46 (3) pp.250- 

54. 

• Scherer, L. A. et al. (2002). The vacuum assisted closure device: a method of 

securing skin grafts and improving graft survival. Archives of Surgery, 137 (8), 

pp.930-934. 

• Nursing and Midwifery Council, 2009. Record Keeping: Guidance for Nurses and 

Midwives. London: NMC. 

• Nursing and Midwifery Council, 2008. The Code: Standards of Conduct, 

Performance and Ethics for Nurses and Midwives. London: NMC. 

• World Union Wound Healing Society, 2008. Principles of Best Practice: Vacuum 

Assisted Closure: Recommendations for Use. A Consensus Document. MEP Ltd, 

London. 

• Xie, X. et al., (2010). The clinical effectiveness of negative pressure wound 

therapy: A systematic review. Journal of Wound Care 19 (11), pp. 491-7. 





Document Control Information 

Ratification Assurance Statement 

Dear 

Mary 

Please review the following information to support the ratification of the below named 

document. 

Name of document: 

Name of author: 

Negative Pressure Wound Therapy 

Kate Purser & Nicola Heywood 

Job Title: 

I, the above named author confirm that: 

Tissue Viability Nurse Specialist 

• The Policy presented for ratification meets all legislative, best practice and other 

guidance issued and known to me at the time of development of the Policy; 

• I am not aware of any omissions to the Policy, and I will bring to the attention of the 

Executive Director any information which may affect the validity of the Policy 

presented as soon as this becomes known; 

• The Policy meets the requirements as outlined in the document entitled Trust-wide 

Policy for the Development and Management of Policies (v4.0); 

• The Policy meets the requirements of the NHSLA Risk Management Standards to 

achieve as a minimum level 2 compliance, where applicable; 

• I have undertaken appropriate and thorough consultation on this Policy and I have 

documented the names of those individuals who responded as part of the 

consultation within the document. I have also fed back to responders to the 

consultation on the changes made to the Policy following consultation; 

• I will send the Policy and signed ratification checklist to the Policy Coordinator for 

publication at my earliest opportunity following ratification; 

• I will keep this Policy under review and ensure that it is reviewed prior to the review 

date. 

Signature of Author: Date: 3 June 2013 

Name of Person 

Ratifying this policy: Mary Lewis 

Job Title: 

Director of Nursing 

Signature: Date: 6 June 2013 

To the person approving this policy: 

Please ensure this page has been completed correctly, then print, sign and 

post this page only to: The Policy Coordinator, John Apley Building. 

The whole policy must be sent electronically to: ruh-tr.policies@nhs.net 





Consultation Schedule 

Name and Title of Individual 

Date Consulted 

Miss Langdon 25/3/2013 

Mr Bishay 25/3/2013 

Mr Dalton 25/3/2013 

Mr Chadwick 25/3/2013 

Mr Krystopic 25/3/2013 

Mr Williamson 25/3/2013 

Mr Budd 25/3/2013 

Mr Pai 25/3/2013 

Miss Winterborn 25/3/2013 

Jan Lynn 25/3/2013 

Rosemary Griffiths 25/3/2013 

Judith Sparkes 25/3/2013 

Lisa Valentine 25/3/2013 

Clare Warren 25/3/2013 

Brenda Duckett 25/3/2013 

Jo Flint 25/3/2013 

Sue Kennedy 25/3/2013 

Caroline Ficke 25/3/2013 

The following people have submitted responses to the consultation process: 

Name and Title of Individual 

Date Responded 

Name of Committee/s (if applicable) 

Date of 

Committee 





Equality Impact: (A) Assessment Screening 

To be completed when submitted to the appropriate Executive Director for 

consideration and approval. 

Person responsible for the assessment: 

Name: 

Nicola Heywood 

Job Title: 

Tissue Viability Nurse Specialist 

Does the document/guidance affect one 

group less or more favourably than another 

on the basis of: 

Yes/No 

Comments 

Race Yes No 

Ethnic origins (including gypsies and travellers) Yes No 

Nationality Yes No 

Gender (including gender reassignment) Yes No 

Culture Yes No 

Religion or belief Yes No 

Sexual orientation Yes No 

Age Yes No 

Disability 

(learning disabilities, physical disability, sensory impairment and 

mental health problems) 

Yes 

No 

Is there any evidence that some groups are affected 

differently 

Yes No 

If you have identified potential discrimination, are there 

any valid exceptions, legal and/or justifiable 

Yes No 

Is the impact of the document/guidance likely to be 

negative 

Yes No 

If so, can the impact be avoided Yes No 

What alternative is there to achieving the 

document/guidance without the impact 

Yes No 

Can we reduce the impact by taking different action Yes No 

If you answered NO to all the above questions, the assessment is now complete, and no 

further action is required. 

If you answered YES to any of the above please complete the 

Equality Impact: (B) Full Analysis

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