This article examines current guidelines and best practice statements for the treatment and management of chronic venous leg ulcers (VLUs). There is a need for continuous professional development (CPD) for community staff, who are constantly under pressure to maintain evidence-based practice when dealing with the complex, clinical and challenging environment associated with chronic venous leg ulcers. This article highlights the importance of patient assessment, management and treatment options, including the gold standard of compression therapy and new options available
Improvement of wound outcomes is a priority for the NHS if the cost of wound management is to be reduced. Failure to undertake a full holistic wound assessment can result in inappropriate and ineffective treatment, resulting in delayed healing, which can have a negative effect on patient quality of life and healthcare resources. NHS England has commissioned a CQUIN scheme for 2017–19. This comprises 13 indicators which seek to improve quality and outcomes of care for NHS
patients, while supporting local areas in delivering their sustainability and transformation partnerships (STPs). The tenth national indicator focuses on ‘improving the assessment of wounds’. This article provides a practical guide to systematic wound assessment for community nurses so that CQUIN targets can be met, and also introduces a new tool from BSN medical, an Essity company, to help nurses in this area.
This article is the second in a two-part series on managing common lower limb problems encountered in primary care. The first article in the series (Brown, 2017) discussed the causes of oedema and its relation to underlying conditions, such as venous disease, lymphoedema and lipoedema. This article investigates skin care, the management of ‘wet legs’ and the different types of compression therapy available to non-specialist community nurses.
Chronic oedema is a soft tissue swelling present for at least three months, most commonly caused by venous and lymphatic impairment. It has a huge impact on quality of life and over time may cause social deprivation. The mainstay of treatment is compression therapy and treatment of the underlying cause. Comfort and acceptability of the compression system is essential. Clinicians need to work with patients to ensure that they are included in treatment decisions and empowered to take charge of their condition.
This article looks at some case reports undertaken during a community initiative, which explored the importance of regularly
reassessing patients’ support surface needs in relation to their general wellbeing, comfort and personal relationships on a long-term basis. The comfort and dignity of patients who are prescribed longterm specialist dynamic mattresses is discussed through real patient stories. The importance of both involving and educating patients and their carers on pressure ulcer identification and preventation is also shown through this community initiative.
District nursing teams are under increasing pressure to cope with demands on their time and the skills to meet the needs of their local community. The author’s local nursing team has been struggling to manage the clinical skill mix required to meet the complex needs of their patients with lower leg wounds who should be treated with compression therapy. The task of managing compression therapy was mainly undertaken by nurses, but it was proving extremely time-consuming — especially when patients needed leg washing and compression treatment for bilateral leg wounds. After successfully using a Velcro™ compression system, a six-month evaluation of juxta products for the leg ulcer pathway was proposed for one community nursing team. This project was undertaken with an initial cohort of 17 patients to evaluate if switching to this product could help to improve the use of the team’s skill mix and reduce costs on wound products from the formulary by improving wound healing rates.
This article focuses on the work of a team of community nurses running a primary care drop-in centre. As well as a full range of clinic services, the team sees a lot of leg ulcer patients for compression bandaging. A common problem with traditional compression bandaging is the amount of time that community nurses have to spend on the procedure, as well as the dangers of maintaining pressure and bandage slippage between dressing appointments, which can result in discomfort for patients and even skin damage in some cases. This also has implications for patient concordance. This article looks at a review by the team of a new compression system (juxtacures®; medi UK), which offers measurable and adjustable compression and a greater involvement by patients in their own care, which in turn can minimise the time nurses need to spend on dressing changes.
The management of exudate in acute and chronic wounds is a common issue for community nurses, with too much exudate resulting in issues with infection and the breakdown of periwound skin; while too little moisture risks the wound bed becoming too dry. Nurses need to find the most cost-effective and clinically proven treatment regimen when treating wounds that produce different levels of exudate, minimising dressing changes and patient discomfort. While it can be difficult to make a choice about which dressing to use because of the vast array on offer, it is important to match the dressing to the wound and use the most appropriate dressing for the levels of exudate being produced. Similarly, using a more responsive approach to wound management — adapting treatment as the wound changes — will result in a more cost-effective approach. Advancis Medical have a range of wound management dressings that are suitable for different wound types and can handle varying levels of exudate. This allows nurses to use a step-up, step-down approach to the management of exudate as the most cost-effective dressing regimen.
The community nurse may come across a range of wounds in the community setting, particularly with the rise in comorbidities such as diabetes and cardiovascular disease due to unhealthy lifestyles and an ageing population. Accurate assessment is the key to identifying the most appropriate wound treatment programme; one that will promote healing and/or relieve symptoms associated with chronic wound healing. Product choice is secondary to getting the assessment process right and accurate assessment and methodical documentation not only help protect against legal challenges, but also aim to reduce waste, dressing change frequency (and thereby nurse time), and patient discomfort. The community nurse should always seek to match their wound-healing knowledge with what they see in the wound bed and the patient’s history, which in turn will enable the nurse to make informed therapy choices and provide expert patient advice.
In recent years, major advances in both the knowledge and practice of wound care have coincided with an increase in the incidence of wounds, due in part to the ageing UK population as well as the increased prevalence of chronic disease and comorbidities, and a rise in clinical and surgical interventions (Myers, 2004).
