Developing a Leg Ulcer Pathway

 

What did we do?

In January 2018 the community nursing team in NHS Orkney recognised that there was no standardised process for the management of patients with leg ulceration, a group was formed to address this.

Aims and objectives:

To create a standardised approach to managing patients with leg ulceration in the East community nursing team focusing on:

Three core care plans were devised to guide the care of patients with; an acute lower leg wound, a chronic leg ulcer and follow up for patients with healed leg ulcers/venous leg complaints, underpinned by the Best practice statement: holistic management of  venous leg ulceration (Wounds UK 2017) and Management of chronic venous leg ulcers (SIGN 2010).  The community nurse would personalise the core care plans with the patient (and if appropriate family and carers) promoting realistic self care and outcomes.  An audit was carried out 6 months prior to implementing the care plans and in the 6 months following.

What went well?

Time taken to carry out Doppler assessment:

Pre pathway: Average 76 days

Post pathway: Average 24 days (down 52 days)

Time taken to heal an ulcer:

Pre pathway: Average 182 days

Post pathway: Average 37 days (down 145 days)

Patients receiving follow up:

Pre pathway: 5/6 patients received follow up

Post pathway: 4/5 patients received follow up (the number of patients requiring follow up would have been greater if the audit period was extended as several patients did not warrant follow up during this time).

What could we improve?

Time taken to carry out Doppler assessment:

Pre pathway: Maximum 138 days

Post pathway: Maximum 55 days (down 83 days)

Although this is a reduction, 55 days is longer than acceptable and this number needs to be further reduced.

What’s next?

Training for the community nursing team on: Doppler, leg assessment and compression bandaging.

Leg ulcer documentation: Develop a checklist and reference file for leg ulceration pathway, aiming to further reduce time taken to carry out a doppler assessment. Create a prompt sheet for individualised care plans to further enhance partnership between patient and nurse ensuring the patient has copy of the care plan.

Repeat audit

RM website – Leg Ulcer Pathway

What’s next?

Training for the community nursing team on: Doppler, leg assessment and compression bandaging.

Leg ulcer documentation: Develop a checklist and reference file for leg ulceration pathway, aiming to further reduce time taken to carry out a doppler assessment. Create a prompt sheet for individualised care plans to further enhance partnership between patient and nurse ensuring the patient has copy of the care plan.

Repeat audit

RM website – Leg Ulcer Pathway