1.3 Explain when an initial tissue viability risk assessment may be required

This guide will help you answer 1.3 Explain when an initial tissue viability risk assessment may be required.

Tissue viability refers to the health of skin and underlying tissues. This topic is important in health and social care, especially when caring for people at risk of tissue breakdown, often called pressure ulcers or bedsores. Protecting skin and preventing injury is key in all care settings.

Looking after skin health involves assessing risks. This process helps to spot dangers early and act before problems develop. A tissue viability risk assessment is a structured way of checking a person’s risk of developing skin damage. Knowing when to carry out this first assessment is important for patient safety and good care practice.

What is a Tissue Viability Risk Assessment?

A tissue viability risk assessment is a detailed check to see if someone is likely to develop skin breakdown. It is often called a pressure area risk assessment or pressure ulcer risk assessment.

This check includes:

• Examining the skin for signs of redness, swelling, or open wounds
• Asking questions about the person’s mobility, nutrition, continence, and medical conditions
• Using tools or scales, like the Waterlow, Braden, or Norton scales, which assign scores to highlight risk levels

The assessment must be clear, structured, and based on evidence. Accurate paperwork and notes are vital, as they show what has been done and inform the care plan. The assessment is not just a tick-box exercise. It forms part of ongoing care and should be taken seriously.

Why Tissue Viability Matters

Poor tissue viability causes great discomfort and can lead to severe health complications. Pressure ulcers can become infected, take a long time to heal, and, in some cases, cause life-threatening problems. Preventing tissue damage is a legal, moral, and professional duty for all carers.

Both national guidelines, such as those from NICE (National Institute for Health and Care Excellence), and local organisational policies insist on structured assessment of tissue viability risk. Failing to carry out this duty may lead to investigation, disciplinary action, or harm to those in care.

When an Initial Risk Assessment Should Be Done

Timing makes a huge difference in reducing the risk of pressure ulcers and skin breakdown. The initial tissue viability risk assessment is the first full check to spot dangers. This section explains when you need to carry out that first assessment.

At Admission or Start of Care

The most common trigger for a first risk assessment is when a person arrives at a new care setting or starts receiving care. This applies to hospitals, nursing homes, residential care, and people cared for at home.

As soon as possible after admission, complete the assessment. Current UK good practice suggests the initial assessment should be done:

• Within 6 hours of admission to hospital
• On the first day of moving into a care home
• At the start of services from health and social care agencies

Staff should not delay unless there is an exceptional reason, such as an emergency that puts life at risk.

Transfer Between Care Settings

When a person moves between different care environments, complete a new tissue viability assessment, even if one was recently done. For example, transfer from hospital to a care home, or from one hospital ward to another, should always prompt a new check.

Key risks may have changed during any admission, hospital stay, or move. A fresh set of eyes may spot developing dangers that others missed.

Change in Health Status

If someone’s health changes, this may mean their risk changes too. Some events to look out for include:

• Sudden illness (such as infections)
• Worsening mobility (e.g., after a stroke or fracture)
• Significant weight loss or poor nutrition
• Sudden incontinence (loss of bladder or bowel control)
• Surgery, including both major and minor procedures
• Any deterioration in general condition (such as confusion, drowsiness, or frailty)

When these things happen, repeat the tissue viability assessment because the person’s risk for skin breakdown might have increased.

After a Fall or Injury

A fall or injury can damage skin or tissue directly. Bruising, skin tears, or restricted movement after a fall make people more prone to pressure ulcers. Any fall, especially for people who are frail or unable to move easily, means a tissue viability risk assessment is needed straight away.

If Skin Damage is Noticed

If you notice any signs of skin damage during personal care—such as a red patch, blister, scrape, or open sore—immediately carry out a full risk assessment. Early skin changes can become serious problems if not picked up. Deal with them quickly to try to prevent further damage.

Change in Care Needs or Support

Sometimes, a person needs more help with personal care or mobility. If their care needs increase, their risk of tissue breakdown may rise too. For instance, if a person who once walked to the toilet now requires a hoist, this change means an updated risk check should be done.

When a Person is Unresponsive or Unable to Report Pain

People who cannot speak or feel easily—such as those with dementia, unconscious, or with certain neurological conditions—may not show or report discomfort. These people are at higher risk. Carry out a tissue viability risk assessment during initial contact, as they might not be able to alert staff to pain or pressure.

Common Triggers for Initial Assessment

Each situation will differ, but look out for the following main reasons to begin the process:

• New admission to any care setting
• Discharge or transfer from hospital
• Return home from treatment or surgery
• Physical health decline
• Reduced awareness or sensation (such as after a stroke, spinal injury, or general anaesthetic)
• Visible changes to skin during washing or dressing
• Unplanned weight loss or malnutrition
• Increased dependency on staff for movement
• New need for specialist equipment (such as a wheelchair, commode, or special mattress)
• After any period of being bedridden, including short stays

Groups of People Who Are At High Risk

Some people are more likely to suffer from poor tissue viability. Always be alert for the following risk groups.

• Elderly adults (natural thinning and reduced healing rates)
• People with physical disability reducing movement
• Those with neurological conditions, like multiple sclerosis or spinal cord injury
• People with sensory loss and unable to feel pain well
• Individuals with poor nutrition or dehydration
• Those who have difficulty with continence
• Critically ill patients, especially those in intensive care
• People who are very underweight or overweight
• Children and babies, who have delicate skin

In all these cases, early and thorough assessment is needed, even if the person looks well on first glance.

Using Standardised Tools

Assessment tools help to make decisions clear and fair. The two most popular in the UK are:

• Waterlow Score: Considers factors like build, skin type, mobility, age, appetite, and presence of specific risks (e.g., surgery, medication)
• Braden Scale: Looks at sensory, moisture, activity, mobility, nutrition, and friction/shear

Use whichever tool your setting recommends. Record the date and results, and explain the findings to the person (or their family) clearly.

Documenting the Assessment

Always write down every assessment. Make sure this becomes part of the person’s care notes. Document:

• The date and time of assessment
• Who completed it
• What tool or method was used
• The score or result
• Any action plan or next steps required

Sound documentation protects both those receiving care and staff members. It provides a clear basis for future checks and can be important in safeguarding and inspection processes.

Communicating Assessment Results

Once the assessment is complete, share results with the care team. A new risk or a change should prompt an update to the care plan.

• Inform those in charge, such as the lead nurse or manager
• Make sure night staff and agency workers have access to this information
• Let family or carers know what has been found, in plain language

Acting on the findings helps to prevent harm and reassures the person and their support network that the right steps are being taken.

Acting on the Risk Assessment

After completing the assessment, use the information to create a support plan. This may include:

• Changing position more often
• Using pressure-relieving bedding or cushions
• Improving dietary intake, with advice from a nutritionist if needed
• Keeping skin clean and dry
• Treating any medical conditions which may increase risk

The goal is always to reduce risk where this is possible and act early if signs of skin damage develop.

Ongoing Assessment

Initial assessment is only the start. Review assessments:

• Daily for people at high risk
• Weekly in longer-stay settings
• Immediately after any changes in health or mobility
• Any time skin damage appears

Record reviews as fully as the original assessment.

Training and Awareness

All staff should receive up-to-date training on risk assessment for tissue viability. Induction programmes should cover:

• Signs of pressure damage
• Manual handling and movement to avoid friction and shear
• Use of risk assessment tools and care plans

Staff awareness means assessments happen on time and people get the support they need.

Final Thoughts

An initial tissue viability risk assessment must be carried out at key points. Start with admission to any care setting, after any change in health, during transfers, and whenever new risks are spotted. Focus on those most at risk by age, condition, or circumstance. Use clear assessment tools. Keep accurate notes and communicate with the care team. Early and effective assessment can prevent harm and help people stay healthy and comfortable in care.