Wound Care Today

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12 WOUND CARE TODAY 2017,Vol 4, No 1
Wound bed preparation
describes the process of
preparing a wound to heal
and is a concept outlined by Schultz
et al (2003). This concept was
then developed into an acronym:
TIME (Box 1) (Dowsett, 2008).
More recently,‘S’, which stands for
surrounding skin, has been added to
the principle of TIME (Wounds UK,
2016; see pp. 44–45).
TIME provides a framework
to guide structured local wound
assessment as part of an overall
holistic assessment of the patient.
The findings of assessment should
then be used by the clinician
to guide treatment of both the
patient and their wound. Repeated
reassessment and documentation
of findings allow practitioners to
TIME to identify and manage tissue
types present in the wound bed
systematically apply appropriate
management strategies which can
then be adapted as the wound
progresses or deteriorates.
The importance of the assessment
process has been recognised in the
recently introduced CQUIN for
wound assessment – Indicator 10
(NHS England, 2017), which aims
to ensure that patients receive a full
wound assessment if their wound has
not healed within four weeks.
In addition to allowing effective
wound management, the assessment
process is a communication tool
between healthcare professionals.
Therefore, it is important that the
assessment process uses a common
and consistent series of terms to
describe and document the wound.
To this end, a core minimum data
set has been developed to support
the CQUIN (Coleman et al, 2017).
The minimum data set consists of
several domains, one of which is
wound assessment, which states that
the tissue type present within the
wound bed should be identified and
documented. Documentation should
be supported by diagrams, illustrations
or photography whenever possible
in line with local policy (Vowden and
Vowden, 2015;Vowden, 2016).
Kathryn Vowden, lecturer, University of Bradford;
honorary nurse consultant, Bradford Teaching
Hospitals NHS Foundation Trust
IN BRIEF
TIME is an acronym that supports systematic wound assessment.
The ‘T’ of TIME represents ‘Tissue types present’ as a reminder to
assess the types of tissue present in the wound bed, and in what
quantity, usually recorded as a percentage of the whole wound bed.
Documentation of these values and communicating to colleagues
means that at each assessment the success or failure of wound
management decisions can be evaluated and reviewed if needed.
KEY WORDS:
TIME
Tissue type
Wound bed preparation
Necrosis/slough
Debridement
Kathryn Vowden
Box 2
Necrosis is caused by factors
external to the cell or tissue, such
as ischaemia, infection, toxins,
or trauma that result in the
unregulated digestion of
cell components.
Eschar (coagulative necrosis)
i Structure similar to
healthy human dermis
with interspersed areas of
disruption and degradation
i Inflammatory infiltrate:
leucocytes secreting
proteolytic enzymes
i Staining demonstrates protein
degradation but a maintained
fibrous structure.
Slough
Creamy yellow often stringy
adherent fibrous material derived
from the breakdown of proteins,
fibrin and fibrinogen (Tong, 1999),
which can recur after wound
cleansing or debridement.
Necrotic tissue may undergo
liquefaction to form a viscous gel-
like material and in the presence
of infection may produce pus.
Box 1
i T issue: non-viable or deficient
i I nfection: inflammation or
biofilm
i M oisture imbalance
i E dge: advancing or undermining
i THIS PAPER WAS SUPPORTED BY