The purpose of the wound assessment chart and guidelines is to assist in assessment and documenting of wounds to improve continuity of care and enhance communication.
Each wound should be numbered and the position marked on the body map
A sketch of the wound should be drawn with size and type of tissue in the wound marked on the sketch. Measure wound at greatest length and breadth (depth if appropriate).
Record other information be circling the options on the chart.
The front page of the chart is designed to be an assessment chart and not to be completed each time the wound is dressed. The continuation sheet should be completed at each dressing change.
The chart should be kept as an integral part of the patient's care plan and should be kept within the patient's notes.
Cross-referencing between the wound assessment chart and the nursing notes will prevent duplication of information.
Reassessment will be dependent on the type of wound and its progress and should be decided by the named nurse for that patient. However, wounds should be reassessed at least once a week as a baseline standard.
If a patient has a leg ulcer, then the Leg Ulcer Assessment Chart should also be completed.
