The TIMERS Framework for Wound Care
A practical approach to assessing and managing wounds
The TIMERS Framework is a structured approach used by healthcare professionals to assess wounds and support healing. Rather than focusing only on the wound itself, TIMERS looks at several important factors that can affect recovery.
Each letter represents a different area to assess:
- T – Tissue
- I – Infection, Inflammation or Biofilm
- M – Moisture Imbalance
- E – Edge of the Wound
- R – Repair, Regenerate or Refer
- S – Surrounding Skin, Social Factors and Supported Self-Care
By considering each part of the framework, healthcare professionals can identify barriers to healing and develop an appropriate treatment plan.
Tissue (T)
Is the wound healthy?
Looking at the wound bed helps determine how well the wound is healing.
Healthy tissue includes:
- Red granulation tissue
- Pink epithelial tissue, which shows new skin is forming
Unhealthy tissue may include:
- Yellow slough
- Black necrotic tissue (dead tissue)
Dead or damaged tissue can delay healing and increase the risk of infection.
Treatment may include
- Removing dead tissue (debridement) where appropriate
- Using dressings that help soften or remove unhealthy tissue
- Compression therapy for suitable leg ulcers
- Referral to a wound care specialist if needed
Important: Foot wounds should not be debrided until the blood supply has been assessed using a Doppler test. Anyone with a diabetic foot wound should be referred to podiatry.
Infection, Inflammation and Biofilm (I)
Recognising infection
Infection can slow healing and increase pain, wound fluid and odour.
Healthcare professionals look for three different stages:
Local infection
The infection is limited to the wound and the surrounding skin.
Treatment may include:
- Antimicrobial dressings
- Good wound hygiene
- Debridement where appropriate
Antibiotics and wound swabs are not usually required for a simple local wound infection.
Spreading infection
When infection spreads into the surrounding skin (cellulitis), further treatment is required.
Treatment may include:
- Oral antibiotics
- Antimicrobial dressings
- A wound swab if there is little improvement
Systemic infection
If infection spreads through the body, people may become generally unwell with symptoms such as fever.
This requires urgent medical assessment.
Moisture Balance (M)
Keeping the wound at the right moisture level
A balanced amount of wound fluid (exudate) helps wounds heal.
Wounds that are too dry
Dry wounds may heal more slowly.
Treatment may include:
- Moisture-donating dressings (where appropriate)
Wounds with too much fluid
Too much moisture can:
- Damage healthy skin
- Cause maceration
- Delay healing
Treatment may include:
- Superabsorbent dressings
- Barrier products to protect the surrounding skin
- More frequent dressing changes if necessary
- Compression therapy for suitable lower limb wounds
Edge of the Wound (E)
Are the wound edges healing?
Healthy wounds gradually become smaller as new skin grows from the edges.
Healthcare professionals check for:
- Rolled wound edges
- Wounds that have stopped reducing in size
- Undermining beneath the skin
- Dry skin or callus around the wound
Treatment may include:
- Protecting the wound edge with barrier products
- Removing dry skin or callus where appropriate
- Referral to the Wound Care Service if healing has stalled
Repair, Regenerate or Refer (R)
When wounds need specialist treatment
Some wounds heal slowly despite receiving appropriate care.
In these cases, specialist assessment may be needed.
Advanced treatments may include:
- Negative pressure wound therapy (VAC or PICO)
- Larval (maggot) therapy for wound debridement
Some people may also need referral to specialist services such as:
- Tissue Viability
- Dermatology
- Vascular services
- Plastic surgery
- Orthopaedics
- Wheelchair services
Surrounding Skin (S)
Looking after the skin around the wound
Healthy surrounding skin is essential for wound healing.
Healthcare professionals assess for:
- Dry skin
- Macerated skin
- Excoriated skin
- Swelling (oedema)
- Varicose eczema
- Cellulitis
- Skin damage caused by incontinence
Treatment may include:
- Regular emollients
- Barrier creams or films
- Compression therapy where appropriate
- Topical steroid creams for inflammatory skin conditions
- Antibiotics if cellulitis is present
Social Factors and Supported Self-Care
Helping you take an active role
Wound healing is not just about dressings.
Your healthcare professional will also consider:
- Your pain
- Nutrition
- Mobility
- Equipment you may need
- Your home environment
- Any factors affecting your ability to care for your wound
Understanding your treatment can help you feel more involved in your care.
Together, you can agree realistic goals, such as:
- Reducing wound fluid
- Improving the appearance of the wound
- Preventing infection
- Achieving complete healing
Supported self-care is encouraged wherever possible.
When to Contact Your Healthcare Professional
Seek advice if:
- Your wound becomes more painful
- Redness or swelling spreads
- There is an unpleasant smell
- Your wound suddenly produces much more fluid
- You develop a fever or feel generally unwell
- Your wound is not improving as expected
Further Information
If you would like further advice about wound care, please contact the Sirona Wound Care Service.
Telephone: 0117 944 9733
Email: sirona.wcs@nhs.net
Your healthcare professional can also refer you to the Wound Care Service if specialist assessment or treatment is needed.
