Lower Limb and Leg Ulcer Assessment and Management (eBook)
496 Seiten
Wiley (Verlag)
978-1-119-90823-4 (ISBN)
Lower Limb and Leg Ulcer Assessment and Management is an indispensable resource for practitioners in primary and secondary care, offering a practical and accessible guide to treating and managing leg ulcers.
This comprehensive text challenges the misconception that leg ulcers are invariably 'chronic'. In practice, proactive management will prevent the harm associated with sub-optimal management. Insights are provided into lower limb assessment, early intervention for ulcer prevention, ulcer types and their causes, along with the influence that swelling and biomechanical changes have on the lower limb. The authors draw on international best practice guidance on lymphoedema, wound pain, wound bed preparation, compression therapy, psychological impact, and evidence-based care to enhance leg ulcer management.
Each chapter aims to facilitate reader comprehension and promote productive patient discussions, empowering healthcare professionals to collaborate with patients and improve leg ulcer management rapidly and effectively.
This multi-disciplinary resource covers:
- Normal venous, arterial, and lymphatic function in the lower leg
- Leg ulceration due to venous hypertension, peripheral arterial disease, and lymphoedema
- Leg ulcers of unusual aetiology, addressing autoimmune and inflammatory disorders such as pyoderma gangrenosum, rheumatoid arthritis, scleroderma, sickle cell, and more
- Musculoskeletal changes in the lower limb, assessment, and management to enhance mobility and calf-muscle function
- Clinical management, with topics like wound management, stages of wound healing, exudate management, holistic assessment including vascular assessment, compression therapy, and Laplace's law
- Pain management with an emphasis on understanding the complexities and features that exacerbate or diminish the pain response
- The personalisation of care, understanding of social determinants of health, and the role of supportive self-management in lifelong management
For professionals seeking evidence-informed approaches to delivering exceptional care, Lower Limb and Leg Ulcer Assessment and Management is an essential companion on the journey to understanding and managing leg ulcers effectively.
Aby Mitchell, Senior Lecturer in Nurse Education, Adult Nursing Department, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London. Aby's clinical experience spans across burns and plastics, primary care, and physical health in community mental health. Aby is a registered specialist practitioner in district nursing and has an MSc in Advanced Practice (healthcare education). Aby is committed to improving patient care through nurse education.
Georgina Ritchie, Executive Director and Director of Education at Accelerate. Georgina brings over two decades of experience in clinical practice and education. Her journey from military nursing in the British Army to leadership roles in the NHS and academia has honed her expertise in community and district nursing. Georgina is a registered community specialist practitioner and a V300 non-medical prescriber, holding an MEd, with a passion for empowering confident clinical practice through education.
Alison Hopkins MBE, Executive Director and CEO at Accelerate. With over three decades of experience in wound care, Alison established the leg ulcer service at Tower Hamlet's District Nursing Service in 1989, beginning a life-long passion for compression therapy and community transformation. In 2019 Alison was awarded an MBE for services to nursing and wound care and holds an MSc in Psychology and Health. In addition to overseeing Accelerate, she continues to contribute to academic journals, and speak at conferences, always seeking to challenge the status quo so that excellent wound and lymphoedema care becomes the norm.
Lower Limb and Leg Ulcer Assessment and Management Lower Limb and Leg Ulcer Assessment and Management is an indispensable resource for practitioners in primary and secondary care, offering a practical and accessible guide to treating and managing leg ulcers. This comprehensive text challenges the misconception that leg ulcers are invariably chronic . In practice, proactive management will prevent the harm associated with sub-optimal management. Insights are provided into lower limb assessment, early intervention for ulcer prevention, ulcer types and their causes, along with the influence that swelling and biomechanical changes have on the lower limb. The authors draw on international best practice guidance on lymphoedema, wound pain, wound bed preparation, compression therapy, psychological impact, and evidence-based care to enhance leg ulcer management. Each chapter aims to facilitate reader comprehension and promote productive patient discussions, empowering healthcare professionals to collaborate with patients and improve leg ulcer management rapidly and effectively. This multi-disciplinary resource covers: Normal venous, arterial, and lymphatic function in the lower leg Leg ulceration due to venous hypertension, peripheral arterial disease, and lymphoedema Leg ulcers of unusual aetiology, addressing autoimmune and inflammatory disorders such as pyoderma gangrenosum, rheumatoid arthritis, scleroderma, sickle cell, and more Musculoskeletal changes in the lower limb, assessment, and management to enhance mobility and calf-muscle function Clinical management, with topics like wound management, stages of wound healing, exudate management, holistic assessment including vascular assessment, compression therapy, and Laplace s law Pain management with an emphasis on understanding the complexities and features that exacerbate or diminish the pain response The personalisation of care, understanding of social determinants of health, and the role of supportive self-management in lifelong management For professionals seeking evidence-informed approaches to delivering exceptional care, Lower Limb and Leg Ulcer Assessment and Management is an essential companion on the journey to understanding and managing leg ulcers effectively.
Introduction
ALISON HOPKINS AND JOSEPH MONTGOMERY
In order to understand the placement of and need for this textbook, it is critical that practitioners understand the resources being used in the management of the lower limb. In order to improve outcomes for patients, we need to critically appraise the resources being used, the waste in the health system and where to focus our attention. Resource management is also part of excellent system management. Unfortunately the collection and analysis of system and patient data concerning those with wounds are not routinely accessible and providers often have to rely on the data of others or studies to make conclusions about their local provision. This has created much paralysis in our commissioning landscape. However, there is some local data that can be accessed and this introduction sets the scene and clarifies the role the insights can play in improving care delivery. Dressing spend will reduce when best practice is utilised and wound chronicity avoided. Thus clinical improvements as a result of increasing readers' knowledge and skills in leg ulcer management will create a profound and positive impact on the health economy.
THE WOUND CARE BURDEN
During 2017 and 2018 it was estimated that more than one million people in the United Kingdom had an active ulcer on the lower limb (Guest et al. 2020). This equates to 2% of the population and is a 37% increase from the prevalence data recorded in 2012 (Guest et al. 2020). More than 50% of these patients were recorded as having venous leg ulceration and approximately 36% of all lower limb wounds did not have a documented diagnosis. This lack of accurate diagnosis indicates that a significant proportion of the population is likely to experience delayed wound healing associated with the absence of effective treatment. The cost of lower limb ulceration cannot be underestimated, as experiencing a leg ulcer is known to be associated with a negative effect on the biopsychological, spiritual and socioeconomic aspects of patients' health, well‐being and quality of life.
Treatment and management of leg ulcers are expensive, and the financial costs of wounds overall are well documented. Approximately £8.3 billion per year are spent on wound management, of which £2.7 billion is associated with managing healed wounds and £5.6 billion is associated with managing unhealed wounds (Guest et al. 2020). In terms of practitioner time, this equates to 54.4 million district or community nurse visits per year, 28.1 million practice nurse appointments and 53.6 million healthcare support worker visits (Guest et al. 2020). It is estimated that 50% of community nursing caseloads is attributed to lower limb wounds (Hopkins and Samuriwo 2022). Missing from the picture is health economics data about the amount of money and time spent by patients, their families and support networks in managing their wounds.
For practitioners this so‐called ‘big data’ can feel disconnected from day‐to‐day practice, but effective resource management is an area that practitioners can influence, through learning about local needs and patterns, choosing the right management plan, analysing and understanding available data and working effectively to be aware of sustainability. Front‐line healthcare practitioners are well positioned to make a difference in resource management and environmental sustainability (Ritchie 2019) for the benefit of the local health economy.
Effective management of resources, whether that is clinical consumables, human time or a commitment to environmental sustainability, has the potential to underpin effective leg ulcer management. When managing resources for the population of citizens who have wounds, it is necessary to be cognisant of the resources being used, those that are obvious and measurable, as well as where we are data poor. This is an important area for practitioners to appreciate and lead on, whatever level of change they are attempting to create, from developing a basic business case to those who wish to promote system‐level change. Table I.1 highlights areas of data that could support a strategy to improve resource management.
TABLE I.1 Data for insight into the use of healthcare resources.
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THE COST OF SUB‐OPTIMAL WOUND CARE
Dressing prescription costs are a known resource within community services alongside the awareness that waste is prevalent and there is a chronic lack of adherence to formularies. This brings an opportunity for cost control and reduction often led by medicines management teams. Less known or understood is the extent of time spent on delivering wound care; this has been reviewed in some studies (Guest et al. 2020; Hopkins and Samuriwo 2022) but it is rare for an area to know accurately how many hours of practitioner time are spent on care delivery. This prevents the development of a comprehensive workforce strategy that will utilise an effective skill mix for the successful management of patient need.
The successful management of lower leg wounds and lymphoedema is very dependent on the skillful use of dressings, compression bandages and compression garments. When evidence based care is utilised for people with leg ulcers, this has a positive effect on spend and patient outcomes, as well as practitioner time. Hopkins and Samuwiro (2022) found that more nursing time was spent on lower limb management when compression was not used; non‐use of compression increased nursing activity by 37%. Analysis of the usage and costs of dressings, compression bandages and compression garments bring insights to direct care delivery at the front line, as well as improving the system‐wide population health management. Yet the insightful management of dressings and bandages as a critical resource remains a rarity in resource management.
Collecting local data on practitioner time, dressing and bandage usage and unplanned admissions remains a difficult task but can provide profound insights into the evidence of sub‐optimal care and unwarranted variation. Persuading commissioners of the worth of investment remains problematic and hence the need for the National Wound Care Strategy to provide a framework for evidence production and business cases. While data may be lacking, enthusiastic local leaders can help commissioners or nursing leaders make system‐changing decisions. Table I.2 offers some tips for how practitioners can develop good resource management practices.
TABLE I.2 Tips on how practitioners can develop good resource management practices.
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CLASSIFICATION OF DRESSING PRODUCTS
Dressings are classified according to their primary purpose, with the exception of some antimicrobial products. Categorising products, as in Table I.3, is beneficial when reviewing the use of dressings and spending attributed to them. This method provides a quick overview of the most‐used or highest‐spending products and brings insight at a glance, while highlighting where further analysis is needed.
TABLE I.3 Product classification.
Classification | Generic examples |
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Absorbent | Hydrofibre, supra‐absorbents |
Antimicrobial | Products with Ag (silver) layer or specific antimicrobial properties |
Bandage | Crepe or retention bandage |
Compression bandage systems | Individual bandages, multicomponent kits, hosiery kits |
Debridement | Skin or wound cleansing wipes or pads, often with microfibres |
Dressing packs | Including gloves and aprons to aid good infection control... |
Erscheint lt. Verlag | 20.3.2024 |
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Sprache | englisch |
Themenwelt | Medizin / Pharmazie ► Pflege |
ISBN-10 | 1-119-90823-X / 111990823X |
ISBN-13 | 978-1-119-90823-4 / 9781119908234 |
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