NATVNS

WOUND ASSESSMENT
Wound Assessment Chart Guidelines
See Guidelines on back page to Complete Form

The purpose of the wound assessment chart and guidelines is to assist in assessment and documenting Affix patient label if available Factors which could delay healing
Name : (Please tick relevant box)
of wounds to improve continuity of care and enhance communication. This chart should be used in
conjunction with local guidelines. Unit CHI No : D.O.B. : Immobility Poor Nutrition

Ward / Address : Diabetes Incontinence

Page 1 Consultant / GP : Respiratory / Circulatory Anaemia

Disease
Complete chart as indicated. Ensure all wounds are numbered and type and duration of wound Body Diagram
Wound Infection Medication
completed. Inotropes
Factors which could delay healing. Oedema Steroids
Chemotherapy
Complete allergies and sensitivities and include wound products which appear to have caused
Other ....................................................................................
similar problems.
Allergies & Sensitivities .......................................................
Feet Diagram
Left Right
Page 2
It is advised to use one formal wound assessment for each wound.
Use continuation sheets if more than one wound.
If infection suspected or signs present consider sending a wound swab to confirm organism.
If photograph obtained please ensure consent obtained. R L

NB. Formal wound assessment is to be completed on initial assessment, when wound bed
changes or every 7 10 days (as per page 2).

Medial Lateral
Page 3 L R
Complete as indicated.
Ensure numbers correspond with the wounds taken from the body / feet diagrams on page 1.
Please ensure you write in primary, secondary and supplementary dressing where appropriate.
Lateral Medial
Please document care of surrounding skin if appropriate.
Use continuation sheets when required.
Use this section for any other relevant information eg, antibiotic commenced.
Mark location with X and number each wound Mark location with X and number each wound
Type of Wound Total number and duration Referred to : (tick all relevant boxes)
(tick all relevant boxes) of each type of Wound TVN Dietician Podiatrist
Pressure ulcer ........................................ Physiotherapist
Leg ulcer ........................................ Other (please specify) ..............................
Surgical wound ........................................ Equipment required :
Diabetic ulcer ........................................ Specialist Mattress Cushion Heel Protector
Other, specify ........................................ Other (please specify) ..............................
0308WA(775)7
4 1
 Formal Wound Assessment Treatment Plan and Evaluation of Care

Complete on initial assessment and reassess if wound bed changes OR 7 - 10 day intervals To be completed when treatment or dressing type altered
Use a separate column for individual wounds NB : PRINT INFORMATION
Date Wound Treatment Plan Frequency Evaluation & Rationale for Signature
Number & Dressing Type changing dressing type
Number of Wound
Date of Assessment
Grade of pressure ulcer (if applicable)
Analgesia required (pre-dressing) Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No
Wound Dimensions (enter size)
Length (cm/mm)
Width (cm/mm)
Depth (cm/mm)
Or trace wound circumference
Is wound undermining
Is wound tracking
Photography
Tissue type on wound bed (enter %)
Necrotic (Black) % % % % % % % %
Sloughy (Yellow / Green) % % % % % % % %
Granulating (Red) % % % % % % % %
Epithelialising (Pink) % % % % % % % %
Hypergranulation (Red) % % % % % % % %
Wound exudate levels and type (tick relevant boxes) * MAY INDICATE INFECTION *
Low
Medium
High *
Exudate - Serous (Straw)
Exudate - Haemoserous (Red / Straw)
Exudate - Purulent (Green / Brown) *
Malodour *
Swab obtained
Skin surrounding wound (tick relevant box)
Macerated *
Oedematous *
Erythema *
Excoriated skin
Fragile
Dry scaling
Healthy / Intact
Treatment objectives (tick relevant box)
Debridement
Absorption
Hydration
Protection
Palliative / Conservative

Assessors Print Initials

Re-assessment Date

2 3
 Formal Wound Assessment Treatment Plan and Evaluation of Care

Complete on initial assessment and reassess if wound bed changes OR 7 - 10 day intervals To be completed when treatment or dressing type altered
Use a separate column for individual wounds NB : PRINT INFORMATION
Date Wound Treatment Plan Frequency Evaluation & Rationale for Signature
Number & Dressing Type changing dressing type
Number of Wound
Date of Assessment
Grade of pressure ulcer (if applicable)
Analgesia required (pre-dressing) Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No
Wound Dimensions (enter size)
Length (cm/mm)
Width (cm/mm)
Depth (cm/mm)
Or trace wound circumference
Is wound undermining
Is wound tracking
Photography
Tissue type on wound bed (enter %)
Necrotic (Black) % % % % % % % %
Sloughy (Yellow / Green) % % % % % % % %
Granulating (Red) % % % % % % % %
Epithelialising (Pink) % % % % % % % %
Hypergranulation (Red) % % % % % % % %
Wound exudate levels and type (tick relevant boxes) * MAY INDICATE INFECTION *
Low
Medium
High *
Exudate - Serous (Straw)
Exudate - Haemoserous (Red / Straw)
Exudate - Purulent (Green / Brown) *
Malodour *
Swab obtained
Skin surrounding wound (tick relevant box)
Macerated *
Oedematous *
Erythema *
Excoriated skin
Fragile
Dry scaling
Healthy / Intact
Treatment objectives (tick relevant box)
Debridement
Absorption
Hydration
Protection
Palliative / Conservative

Assessors Print Initials

Re-assessment Date

2 3
 NATVNS
WOUND ASSESSMENT
Wound Assessment Chart Guidelines
See Guidelines on back page to Complete Form

The purpose of the wound assessment chart and guidelines is to assist in assessment and documenting Affix patient label if available Factors which could delay healing
Name : (Please tick relevant box)
of wounds to improve continuity of care and enhance communication. This chart should be used in
conjunction with local guidelines. Unit CHI No : D.O.B. : Immobility Poor Nutrition

Ward / Address : Diabetes Incontinence

Page 1 Consultant / GP : Respiratory / Circulatory Anaemia

Disease
Complete chart as indicated. Ensure all wounds are numbered and type and duration of wound Body Diagram
Wound Infection Medication
completed. Inotropes
Factors which could delay healing. Oedema Steroids
Chemotherapy
Complete allergies and sensitivities and include wound products which appear to have caused
Other ....................................................................................
similar problems.
Allergies & Sensitivities .......................................................
Feet Diagram
Left Right
Page 2
It is advised to use one formal wound assessment for each wound.
Use continuation sheets if more than one wound.
If infection suspected or signs present consider sending a wound swab to confirm organism.
If photograph obtained please ensure consent obtained. R L

NB. Formal wound assessment is to be completed on initial assessment, when wound bed
changes or every 7 10 days (as per page 2).

Medial Lateral
Page 3 L R
Complete as indicated.
Ensure numbers correspond with the wounds taken from the body / feet diagrams on page 1.
Please ensure you write in primary, secondary and supplementary dressing where appropriate.
Lateral Medial
Please document care of surrounding skin if appropriate.
Use continuation sheets when required.
Use this section for any other relevant information eg, antibiotic commenced.
Mark location with X and number each wound Mark location with X and number each wound
Type of Wound Total number and duration Referred to : (tick all relevant boxes)
(tick all relevant boxes) of each type of Wound TVN Dietician Podiatrist
Pressure ulcer ........................................ Physiotherapist
Leg ulcer ........................................ Other (please specify) ..............................
Surgical wound ........................................ Equipment required :
Diabetic ulcer ........................................ Specialist Mattress Cushion Heel Protector
Other, specify ........................................ Other (please specify) ..............................
0308WA(775)7
4 1