Early interventions using the Best Practice Leg Ulcer Treatment Pathway
In April 2017 I joined my current Trust in North Lincolnshire and Goole as a Tissue Viability Specialist Nurse. I was keen to find out the leg ulcer prevalence and what treatments were currently being used. After hearing Dr. Leanne Atkin talking about the Best Practice Statement implementation in Mid Yorkshire at the Right Care: Right Time event, I was further inspired to look at this in my area!
After doing a mini-audit on patients with lower limb wounds on the district nurse caseloads, the results mirrored the national Guest et al. study (2016) on the Burden of Wounds. Only a third of patients had received a Doppler assessment and those with a normal ABPI were in reduced compression.
Leg Ulcer training back on the Agenda
Early interventions using the Best Practice Leg Ulcer Treatment Pathway
There had not been leg ulcer training for a while, so education and competency needed revisiting. The challenge was knowing where to start!
One cannot achieve big changes alone, so with the support of L&R, the Leg Ulcer Treatment Pathway was adapted to suit products on our current formulary. We also wanted to implement a pathway that clinicians could easily follow, with patient comfort as key, to ensure their concordance and therefore increase healing results.
As with anything new there was a degree of scepticism! Undeterred we piloted a four-day course on Leg Ulcer Assessment and Management with Community District and Practice nurses. It immediately became evident that a new movement and enthusiasm was in the air!
The results I have witnessed have been amazing!
I have seen the healing of long-standing leg ulcers, the positive reactions from patients, who prior to this had declined compression fearing pain, discomfort and lifestyle changes. However once in a two-layer system or hosiery kits they had no issue with concordance and expressed relief and happiness to finally have their legs healing or healed. Importantly all the health care professionals felt empowered with a tool kit and pathway to assist their practice. I was receiving calls from excited nurses requesting I look at leg ulcer photographs, not for advice but to demonstrate what a great result they had experienced.
‘’It works’’ they say ‘’I know’’ is my reply!
The Trust took the step to ensure that the Leg Ulcer training is now mandatory for all district nursing staff of band 4 and above. We can be positive that our workforce is competent, skilled and knowledgeable in all things leg ulcer, and that our patients are receiving the best care available from evidence-based practice. What could be more rewarding and a forward step in reducing the burden of leg ulcers that we know is out there.
#LegsMatter
Alison Schofield, Tissue Viability Team Lead & Clinical Nurse Specialist MSc, BSc (Hons) RN, North Lincolnshire and Goole NHS Foundation Trust