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?
Now more than ever, the NHS is searching for ways to reduce wastage and achieve efficiency savings, while at the same time improving patient outcomes. One area which can sometimes be overlooked when it comes to innovation and new ways of working is wound care.
Chronic wounds create poor health (e.g. infection and immobility) and personal issues for patients (e.g. malodour, pain and sleepless nights), as well as substantial costs to healthcare systems (Guest et al, 2017; Atkin et al, 2019). They present many clinical challenges, but two key areas are wound bed preparation and exudate management (Atkin et al, 2019), which are intrinsically linked. A chronic or cavity wound bed which has not been prepared for healing through cleansing and debridement (Mahoney, 2020), containing slough, necrotic tissue or wound biofilm, usually produces a high volume of exudate (World Union of Wound Healing Societies [WUWHS], 2019).
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?
Now more than ever, the NHS is searching for ways to reduce wastage and achieve efficiency savings, while at the same time improving patient outcomes. One area which can sometimes be overlooked when it comes to innovation and new ways of working is wound care.
Chronic wounds create poor health (e.g. infection and immobility) and personal issues for patients (e.g. malodour, pain and sleepless nights), as well as substantial costs to healthcare systems (Guest et al, 2017; Atkin et al, 2019). They present many clinical challenges, but two key areas are wound bed preparation and exudate management (Atkin et al, 2019), which are intrinsically linked. A chronic or cavity wound bed which has not been prepared for healing through cleansing and debridement (Mahoney, 2020), containing slough, necrotic tissue or wound biofilm, usually produces a high volume of exudate (World Union of Wound Healing Societies [WUWHS], 2019).
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.
