Clinical Decision Support · HA-aligned Decision Guide · Bedside Tool
♥Gentle & Caring Care
1 · Wound IdentityRequired fields marked *
Source of truth: Wound-Type Care Plan Excel grades 0–5 (not GLOBIAD).
Dimensions(optional)
2 · TIME & Periwound FrameworkTotal: 0%
Tissue status(must total 100%)
Epithelialization (pink)
Granulation (red)
Slough (yellow / green)
Necrosis (black / brown)
⚠ Black tissue detected — Step 2 pathway requiredAny necrosis % routes to Black Tissue Pathway (Decision Guide). Select subtype:
Surrounding / periwound skin
3 · Red-Flag Gate (Step 1)
6-Point Infection Checklist
Any checked item = infection red flag → temporary cover + refer Wound Nurse → STOP (no Step 3).
🛑 Infection red flag activeImmediate action: CHX 0.05% aqueous then dry gauze temporary cover. Refer Wound Nurse. Do NOT select routine Step 3 dressings.
Peripheral / critical ischaemia
Critical ischaemia suspected
Rest pain · known ABI <0.5 · cold pale foot · absent pulses · new gangrene
🛑 Critical ischaemia red flagKeep dry → protective non-adherent cover. Refer Wound Nurse / Vascular. Do NOT compress, self-debride, or moisturise.
⚠ Edge red flag (E5 / E6 / E8)Temporary cover + refer Wound Nurse. E8: keep dry, no moisture, no compression. Do not rely on dressing alone.