Venous Leg Ulcer Patient Journey and Digital Service Development
Kate Moran – Tissue Viability Nurse - Western Health and Social Care Trust
Aim
It is reported within Ireland that 1 in 500 people suffer from Leg ulceration (1). This is noted by the author and their wound care specialist team based in Northern Ireland. They found that leg ulcers have been on the increase placing an increased burden on their wound care services.
The author understands the importance of wound care as they previously have suffered from a burn wound to the lower leg (Fig. 1). Having the experience of a wound led the author and clinical team to implement changes to the service which would increase their positive healing rates while maintaining a high standard of care.
This is supported by Guest et al (2) who explains leg ulcers cost the NHS £1.94 billion. The author focused on patient outcomes and measured the improvement which included odour management, debridement of devitalised tissue and exudate management which all have an impact on patient wellbeing.
Whilst aiming to increase positive healing outcomes the author and clinical team highlighted the need to make changes to the patient referral system. The author investigated the implementation of a digital advice service to offer support for healthcare professionals treating multiple wound types including burns. The author and clinical team planned to implement a digital referral system that could enhance communication but also increase their productivity.
Method
- Reform and reshape the tissue viability service to meet the needs of its service users.
- Develop a triage service for patients which included digital images
- Develop a virtual care plan.
- Measure and document wound outcomes.
- Meeting to encouraging colleagues to engage and prove that this is a credible model of care delivery.
- Build a multidisciplinary team to support and implement a digital service, Integrated Care Teams (ICT), Information Governance, Tissue Viability Team (3 TVNs and 1 Lead TVN), Acute Nurses, District Nurses (Fig.2)
- Review the service after a year to check its suitability.
- Two case studies where selected one of which was the author.
Results/Discussion
The Author and their team recognised the need for service development. They had the option to continue or make changes. The author was also aware that referrals were increasing along with demands on the service. The team decided to make changes and focus on the referral system and how they delivered care plans to their service users.
The redesign of the service has led to more timely responses to referrals and has allowed the Tissue Viability Team to continue to provide an evidence based service to those patients with complex wounds. Patient one featured in fig 3 was a venous leg ulcer patient. The Images show progression of a patient with a Venous Leg Ulcer treated with, compression, skin care regime, honey and given patient advice from the author including nutrition.
Once the digital service had been implemented the overall feedback from patients and staff across acute and primary care with regards to this service redesign has been positive in relation to patient/staff experience and organisational goals
To quantify the authors experience an audit was conducted and the Tissue Viability Team not only maintained referrals and reviews but the number of referrals increased from 436 to 889 in one month and the new integrated digital system was able to cope with it.
Fig.3
4 days with honey
30 days with honey
42 days with honey
Patient two was the author herself and she received this burn on her leg whilst visiting a friend who had made an outdoor firepit.
Fig.4
Day 1, Enzyme Alginogel and absorbent foam adhesive applied to the wound bed. Wound exudate increased and then became infected. Antibiotics prescribed due to infection
Day 4, Switched to *honey dressing and bandages as wound infected and exudating highly.
Day 10, Wound has less exudate, wound infection settled but some superficial slough needing debriding
Majority of the wound is healed now with purple scar tissue. Scar wound care product used with compression hosiery for next 6 months
Wound healed with minimal scar tissue viable
Conclusion
The author found by implementing new services like the digital advice service they were able to utilise the time saved to offer the tissue viability service to more areas like outpatients. They also established suitable products to help manage patient outcomes improving patient wellbeing. The feedback from healthcare professional and patients shows that the implemented digital service has helped enhance their service
References
2, Julian F Guest , Graham W Fuller, Peter Vowden, Cohort study evaluating the burden of wounds to the UK's National Health Service in 2017/2018: update from 2012/2013