Professor Angela Tod Elizabeth Dinsdale, Catherine Homer, Dr Simon Palfreyman

Transcription

1 Professor Angela Tod Elizabeth Dinsdale, Catherine Homer, Dr Simon Palfreyman

2 Obesity has been identified amongst other factors as a cause of lower limb ulceration due to its contribution to venous hypertension in the leg. Treatment and management of leg ulcers becomes more difficult, and less effective, in obese patients. Obesity may also impact on the provision of care obese patients may receive. There can be a need for additional resources, equipment, procedures and protocols.

3 This study is one of three obesity related co-production projects that are currently underway within Sheffield Teaching s Foundation Trust. Expectations and experiences of weight loss surgery (Photovoice) Weight gain following stroke Leg ulcer care and obesity The projects are partially funded by the Obesity theme of the NIHR Collaboration for Leadership in Applied Health and Research Care (Clahrc) for South Yorkshire.

4 To consider the additional care needs for overweight and obese patients with leg ulcers. To produced descriptions of the process of care for obese leg ulcer patients.

5 To explore the additional care needs required by overweight and obese patients with leg ulcers. Describe the different aspects of the service received by patients within hospital and community settings. Examine the capacity of the services to meet the additional care needs. Identify how service could be improved to deliver care to meet additional needs and prevent further deterioration in terms of both leg ulcer and weight.

6 A qualitative study using semi-structured interview (n=18) and one focus group (n=12) with a wide range of healthcare professionals Two patient interviews were also conducted, one with a patient who received their care at home, and one who received their care at a community Tissue Viability Clinic Data was collected April-November 2013 and analysed using Framework Analysis techniques.

7 Obese/Leg Ulcer Patient Pathway Following consultation with an advisory group of various clinical staff, a leg ulcer patient pathway was developed which identifies staff groups likely to be involved in the care of a patient with a leg ulcer. Interviews were then conducted with volunteers from this pathway. Community GP Practice nurse Social care South Yorkshire Ambulance Service / Patient Transport Services District Nurse/support worker Tissue Viability - Nurse Specialist Community Matron Community Allied Health Professionals (Physio/OT) Bed manager Nursing Staff/ Link Nurses Allied Health Professionals (Physio/OT) Tissue Viability Nurse Specialist Moving and Handling Lead Discharge Liaison Nurse Dietician Porters X Ray/CT Department Nurse Director

8 Interviews Role Dietician Occupational Therapist Moving and Handling Lead Podiatrist ITU Sister Staff Nurse GP Bariatric Nurse Specialist Physiotherapist TV Nurse Specialist Matron Patient Flow Occupational Therapist TV/Vascular Nurse Specialist Lead Nurse Discharge Sister Physiotherapist Physiotherapist Tissue Viability Nurse Setting Community Community ` Community Community Community Community Focus Group Role Speciality/Setting Practice Development Surgery Advisor Moving and Handling Medicine Advisor Sister POSU/ITU/HDU Clinical Educator WPH Senior ODP RHH Clinical Skills Teacher Medical Education Clinical Educator Neurology Clinical Education Site Lead Operating Services RHH Sister Renal Staff Nurse Vascular Angio Senior II Physiotherapist Therapy Services

9 Interviews were recorded and transcribed verbatim, Identifying detail was removed from the data After eight interviews has been transcribed 10 initial codes were developed by two of the researchers based on the data so far As further interviews were conducted the data produced was added to the initial codes where appropriate, or further new codes were developed

10 Patient (staff perception of) Staff Organisation Who and How many What difference does obesity make to developing a leg ulcer Patient Experiences Knowledge and awareness of overweight/obesity Attitudes Role (raising the issue) Impact of weight on care provision Equipment/Resources Training Setting

11 may not get typical or usual care or treatment due to size delayed in rehabilitation and discharge get a poor deal lack of dignity due to poor set up it s not their fault and it s not the staffs fault.its a poor set up NHS is getting better because we have to deal with more overweight and obese people

12 Everything is more complicated and time consuming Large patients get left till last Complex and time consuming discharges More physically demanding Extra staff needed not considered or allowed for Staff over-estimate how many people will be needed If someone can move themselves then it doesn t matter if they are overweight or obese

13 I m happy to raise the issue I m not comfortable bringing it up so I wouldn t It needs to be done sensitively I think I have a good route in due to my job Not easy to do.difficult conversation Whose role is it?...hard to approach.i worry about complaints It s difficult for ward staff to do in a short stay Worry about mental bullying perception Plant the seed but no time to do more than that Staff have a responsibility to help with any healthcare issue smoking or weight

14 Setting space limitations due to hospital design.some areas are better than others challenging in the community not the right environment to manage people Equipment and resources most useful equipment not funded.there are arguments about who funds rehab equipment we might have the right equipment but no one can find it have 15min slot per patient but can take up to 90mins for obese patients problems ordering and getting equipment into homes causes long waits lack of bariatric beds and rooms in the community for offsite rehab.people have to stay in hospital till they are available

15 Healthcare providers need to recognise that increasing numbers of obese patients present challenges to care delivery Patient: There is an impact on patient experience in terms of dignity, safety and quality Practice: Challenges delivering the basics of care for patients with LU who are over weight or obese Staff: Training and referral mechanisms Supporting them to support the patients Organisation: Cost, LOS - complications and delay, equipment Care pathway delays and referral Obesity is considered to be a LTC but strategically often doesn t sit anywhere within healthcare

16 Caring for obese patients impacts on many different areas of care Obesity is considered to be a long term condition but strategically often doesn t have a considered position within healthcare Healthcare professionals often lack confidence and skills to raise weight loss with patients