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Run: Wound Bed Assessment with TIME Framework

Document wound bed status with the TIME framework in one structured assessment. Capture tissue, infection/inflammation, moisture, and edge findings to guide ...

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Assessment Scope and Wound Identification

Wound location and laterality documented

Record the anatomical location, side, and any wound identifier used in the chart.

Wound type or etiology documented

Identify the likely wound type or cause to support appropriate wound bed preparation.

Wound measurements recorded

Document length, width, and depth, and note undermining or tunneling if present.

Photo evidence captured when policy allows

Attach a wound photo if permitted by facility policy and consent requirements.

Assessment date and time recorded critical (required)

Capture when the wound bed assessment was completed.

T - Tissue

Predominant wound bed tissue identified critical (required)

Select all tissue types present in the wound bed.

Viable tissue percentage estimated

Estimate the approximate percentage of viable tissue in the wound bed.

Nonviable tissue burden documented

Rate the amount of slough, eschar, or necrotic tissue present.

Debridement need or tissue management plan noted

Document whether debridement is indicated or whether current tissue management is appropriate.

Signs of stalled healing related to tissue status documented critical (required)

Note whether tissue appearance suggests delayed healing or need for escalation.

Yes No N/A

I - Infection / Inflammation

Local infection signs assessed critical (required)

Select all local signs present, such as erythema, warmth, swelling, pain, purulence, or malodor.

Systemic infection indicators reviewed critical (required)

Assess for fever, chills, tachycardia, or other systemic concerns requiring escalation.

Yes No N/A

Drainage characteristics documented

Record drainage amount and character as part of infection surveillance.

Infection concern escalated when indicated critical (required)

Confirm whether provider notification, culture, or other escalation was completed when infection was suspected.

Yes No N/A

Antimicrobial or infection-control plan documented

Document any topical antimicrobial use, culture plan, or infection-control follow-up.

M - Moisture

Wound moisture balance assessed critical (required)

Rate whether the wound bed is too dry, balanced, or excessively moist.

Periwound maceration or desiccation noted

Select any moisture-related periwound findings.

Drainage amount documented

Document the amount of exudate to guide dressing selection and moisture management.

Moisture management plan documented

Document dressing choice, absorbency, barrier protection, or hydration strategy as appropriate.

Moisture-related complication requires intervention critical (required)

Indicate whether moisture imbalance is causing deterioration or requires escalation.

Yes No N/A

E - Edge and Periwound

Wound edge condition assessed critical (required)

Select all edge findings present.

Periwound skin condition documented

Document surrounding skin findings such as erythema, fragility, induration, or intact skin.

Edge management or offloading plan documented

Document interventions such as offloading, edge protection, or referral for advanced wound care.

Need for escalation due to wound edge deterioration critical (required)

Indicate whether wound edge findings require provider review or wound specialist referral.

Yes No N/A

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