To effectively deal with complex wounds, the importance of oedema and that all oedemas are on a lymphoedema continuum needs to be understood. The efficiency of lymphatic drainage is paramount to oedema management and wound healing. Therefore, interventions to help prevent damage to lymphatic capillaries, and techniques to facilitate lymphatic drainage and lymphangiogenesis should be considered as part of wound management. This article highlights the importance of the lymphatic system in the treatment of leg ulceration and the emergence of a new ‘hybrid nurse’, who combines the specialisms of tissue viability and lymphoedema to improve patient outcomes, reduce waiting times, and improve efficiency within the NHS with the provision of a one-stop service.
With pressure ulcers remaining a challenge to the healthcare system across all care settings, this 12-week pilot study aimed to evaluate implementation of the SEM Scanner as an adjunct to standard of care (SoC) in pressure ulcer (PU) prevention. Two district nursing bases enrolled 17 palliative care patients, who received SoC and preventive interventions. Patients with Waterlow scores 10–19 who were able to be scanned for three consecutive days were included. Broken skin was not scanned, and visual skin checks were documented after SEM scans. Patients with SEM delta ≥0.6 were considered at high risk and preventive interventions were escalated using a clinical decision matrix aligning with SoC. The study found that implementing the SEM Scanner in an existing PU prevention pathway resulted in a reduction in community-acquired PU (CAPU) incidence by 26.7% from 16.1% to 11.8%; 88% (n=15) of patients remained PU free. Furthermore, clinical judgement informed by SEM deltas resulted in 82% (n=14/17) of nurses reporting that the SEM delta had changed their clinical decision-making.
Chronic oedema is a common condition which is increasing in prevalence, yet is still often under-recognised and mismanaged in community settings. Any oedema is a sign that the venous and lymphatic systems are not working properly. Without early identification and intervention, the condition can worsen, resulting in the need for complex care. Using a case history, this article highlights the inappropriate and ineffective use of medicinal management of a patient with lymphorrhoea (i.e. wet, ‘leaky’ legs). As a result of health assessment and a review of management and medication, deprescribing was effectively implemented in this case. The patient was provided with compression hosiery and education, and supported by a Healthy Legs clinic in the South Eastern Health and Social Care Trust, with positive outcomes for the patient, treatment room and GP. The case demonstrates how good practice uses health assessment and symptom analysis to determine diagnosis and appropriate treatment options. It also poses the question: is pharmacology always the answer?
It is estimated that there are currently over 145,000 people diagnosed with Parkinson’s disease in the UK. This progressive neurological condition affects people in a variety of ways, depending on numerous factors, including the impact and severity of their motor and non-motor symptoms. In relation to the current Covid-19 pandemic, the UK government identified people with Parkinson’s disease as clinically vulnerable, suggesting that they were at higher risk of severe illness if they contracted the Covid-19 virus. The subsequent self-imposed isolation could potentially impact on Parkinson’s symptom control, and also affect wellbeing and quality of life. The Parkinson’s disease nurse specialist has had to rapidly adapt service delivery to ensure that the needs of people with Parkinson’s disease are addressed, predominantly with remote assessment, during the Covid-19 pandemic.
In each issue we investigate a hot topic currently affecting you and your community practice. Here, Alison Hopkins MBE, chief executive, Accelerate, explores - Why optimising therapeutic compression is essential.
Tabloids in recent years have indicated that the older generation are becoming a burden on society, citing cost of pensions, social care and the older person having the potential to overwhelm the NHS system. For many young people, the retirement generation evokes images of inactive older people. Yet, many seniors are living longer and enjoying better health into their later years, with retirement becoming an extremely active phase of life.
Current Covid restrictions have forced many healthcare professionals to embrace technology and work in very different ways. Indeed, the traditional telephone has allowed the Newcastle continence service to provide a service to patients referred with all types of urinary incontinence. But, is it even possible to assess someone’s continence and devise a treatment plan over the telephone?
It is estimated that one in 12 children and young people in the UK suffer with a wetting or soiling problem, which can have a devastating impact on their family life, social life and self-esteem (NHS Modernisation Agency, 2003). Afraid of wetting themselves in class or on a school trip; too many children and teenagers are missing out on sleepovers and camping trips, being bullied and constantly trying to hide the signs of their ‘secret’.
Few healthcare professionals, if any, cannot be unaware of sepsis and its clinical consequences. Publicity surrounding sepsis, initiated in no small way by the UK Sepsis Trust (sepsistrust. org), has used the shocking data on morbidity and mortality to bring a closer focus on the problem. This brief editorial review is aimed at providing an essential introduction to the basics of recognition and the urgent actions related to suspicion of sepsis, and some of the essential links to resources and guidelines aimed at early detection. A subsequent article will cover the lived experience of recovering patients post-sepsis in an attempt to highlight the pressing ongoing social and healthcare needs.
