1.0 PATIENT CARE including Physical Healthcare

Transcription

1 SECTION: 1.0 PATIENT CARE including Physical Healthcare POLICY/PROCEDURE: 1.32 NATURE AND SCOPE: SUBJECT (Title): POLICY TRUST WIDE LOWER LEG WOUNDS MANAGEMENT To provide clear direction and guidance to ensure a consistent approach to the management of leg ulceration throughout Nottinghamshire Healthcare NHS Foundation Trust DATE OF LATEST RATIFICATION: AUGUST 2016 RATIFIED BY: PATIENT SAFETY & EFFECTIVENESS COMMITTEE REVIEW DATE: JULY 2019 IMPLEMENTATION DATE: AUGUST 2016 ASSOCIATED TRUST POLICIES & PROCEDURES: NONE ISSUE 2 AUGUST 2016

2 UNOTTINGHAMSHIRE HEALTHCARE NHS FOUNDATION TRUST ULOWER LEG WOUNDS MANAGEMENT UCONTENTS 1.0 Introduction 2.0 Policy Statement 3.0 Definitions 4.0 Scope 5.0 Roles and Responsibilities 5.1 The Associate Director (Nursing, Quality and Patient Experience) 5.2 Tissue Viability Service 5.3 Heads of Service 5.4 Individual Professionals 5.5 Leg Ulcer Clinic Co-Ordinators 6.0 Risk 7.0 Training 8.0 Monitoring Compliance 9.0 Review Date 10.0 Equality Impact Assessment 11.0 Expert Writer 12.0 References Appendix 1 - Record of Changes Appendix 2 - Employee Record of Having Read the Document ISSUE 2 AUGUST

3 1.0 UINTRODUCTION Lower Leg Wounds Management 1.32 UNOTTINGHAMSHIRE HEALTHCARE NHS FOUNDATION TRUST UPOLICY FOR THE MANAGEMENT OF LOWER LEG WOUNDS 1.1 This policy relates to the management of all lower leg wounds. Lower leg wounds all begin with an acute phase and dependent on the cause this will determine the treatment plan. 1.2 A leg ulcer is defined as 'the loss of skin below the knee on the leg or foot, which takes more than 6 weeks to heal' (CKS 2012). Leg ulcers are further separated into venous, arterial, diabetic, vasculitic trauma and malignant. 1.3 Venous disorders of the leg are thought to affect up to one third of the adult UK population (Moffatt, Martin and Smithdale, 2007) and venous leg ulceration affects at least 1 % of the UK population (Morison, Moffatt and Franks, 2007). 1.4 Of all leg ulcers approximately 70% are venous in origin, with arterial disease being the second most common cause approximately 21%. Sufferers can have both diseases simultaneously and there are other associated causes such as rheumatoid arthritis, malignancy, blood disorders, and lymphedema and skin diseases. 1.5 In the UK the majority of patients with leg ulcers receive care in a primary care setting (Moffatt, Martin and Smithdale, 2007) where initial assessment and treatment can be delivered with referral to secondary care for patients who require more complex investigation and treatment. 1.6 Successful leg ulcer management relies upon, early intervention, accurate assessment and treatment. The key to assessment is establishing the underlying cause of the leg ulceration for appropriate treatment regimes to be delivered. Many leg ulcer sufferers have complex problems and patients who fail to respond to treatment should be referred to specialist practitioners in this field. This policy is to ensure consistent standards of care are implemented for patients receiving assessment, treatment and specialist referral by practitioners throughout Nottinghamshire Healthcare NHS Foundation Trust (the Trust). 1.7 Diabetic foot ulcers are complex chronic wounds which have a long term impact on morbidity, mortality and quality of patient s lives the management of which sits outside this policy 2.0 UPOLICY STATEMENT 2.1 The Trust is committed to improving healing rates, reducing the recurrence and promoting the quality of care of leg ulceration based upon research and clinical evidence. In order to do this, the organisation will ensure that: Every patient who presents with a wound on the lower limb will have an initial and ongoing wound assessment. Consent should also be obtained for photographing the wound initially and at assessment reviews. If a wound on the lower limb fails to heal or improve significantly within 6 weeks a full leg ulcer assessment, including measurement of ankle brachial pressure index (ABPI), will be carried out by a suitably qualified and competent practitioner. ISSUE 2 AUGUST

4 All practitioners carrying out a Full Leg Ulcer assessment will have attended organisational training in lower leg wound management If a university accredited course which includes leg ulcer management, assessment and treatment has been attended the individual practitioner will need to discuss with the Tissue Viability Nurse Specialist if further education is required locally. All practitioners carrying out ankle brachial pressure indexes (ABPI) or compression bandaging will have attended training as detailed above and will have accessed additional training and practice as required to demonstrate proficiency in the procedure. Where possible, patients for treatment with compression bandages will attend a leg ulcer clinic or complex wound care clinic The complex wound clinic will offer a management and healing service which includes the assessment, treatment, and education of on-going care plans for patients. Following healing each patient will have a clinical management plan to prevent recurrence of their leg ulcers, which will encompass the prescribing of compression hosiery. All patients should then have a minimum annual ABPI If remained healed to prevent re-occurrence If the patient has a wound that does not heal within 6 weeks then ensure referral to either Tissue Viability Team or Complex Wound Care Clinic is made. 3.0 UDEFINITIONS Arterial leg ulceration ulcers caused by insufficient arterial circulation are not treated in compression bandaging unless further assessments and/or treatments have taken place. Venous ulceration ulcers caused by poor venous return which are treated in compression bandaging Ankle brachial pressure index (ABPI) the circulatory assessment which measures blood pressure at the ankle range of is deemed as normal. Measured using Doppler ultrasound. Community leg ulcer clinic Primary care based clinic for the assessment of leg ulcers and the treatment of leg ulcers which are suitable for treatment with compression bandages. Compression therapy Therapy (bandages or stockings) the ability to apply measurable levels of compression to the lower limb to promote venous return. These require application training for the correct levels of pressure to be reached and can be damaging to healthy tissue if incorrectly applied. Full leg ulcer assessment Assessment which includes a holistic assessment of the patients past and present medical history, signs and symptoms of venous and arterial disease, ulcer characteristics and wound assessment with a circulatory assessment to measure ABPI. Wound assessment The assessment which looks at the wound site and details the dimensions, wound bed type, pain and signs of infection. ISSUE 2 AUGUST

5 On going ulcer review The on-going wound assessment during ulcer treatment. Leg ulcer re-assessment Following healing when the patients are recalled/revisited for a reassessment of their skin and circulation as follow up to prevent ulcer recurrence. 4.0 USCOPE 4.1 This procedure applies to all patients with lower leg wounds who receive services from the Trust. 4.2 All staff employed by the Trust who have direct contact with, and take decisions on the treatment of patients regarding the management of lower leg wounds. 5.0 UROLES AND RESPONSIBILITIES 5.1 UThe Associate Director (Nursing, Quality and Patient Experience) The Associate Director is responsible for ensuring senior management support for the assessment and management of leg ulcers within Notts. Healthcare NHS Foundation Trust. The Associate Director will ensure that senior management receive regular information and reports to inform decision making and to provide assurance that this is being implemented across Notts. Healthcare NHS Foundation Trust. 5.2 UTissue Viability ServiceU The Tissue Viability Specialist Nurses are responsible for ensuring that all training that is delivered to staff is up to date and relevant. The Tissue Viability Specialist Nurses will be responsible for advising upon the development and implementation of systems for the monitoring of healing rates in leg ulcer clinics and patients in the community setting The Tissue Viability Specialist Nurses are responsible for the development and audit of procedure and best practice guidance relating to lower leg wounds The Tissue Viability Specialist Nurses are responsible for assisting with the development of practice and updating the leg ulcer clinic co-ordinators via meetings and link-nurse systems The Tissue Viability Specialist Nurses are responsible for advising upon the development of documentation to promote best practice procedures. Currently this includes; 5.3 UService Managers Lower leg assessment template (within electronic patient record system) Lower leg wound reference guide Service Managers are responsible for ensuring that the standards within this Policy are adhered to by the staff in the services for which they are responsible. They will also ensure improvements to services which are identified from the above monitoring systems and processes are implemented Service Managers are also responsible for ensuring that all staff is appropriately trained. ISSUE 2 AUGUST

6 5.4 UIndividual Professionals Holistic assessment is the responsibility of the inter-disciplinary team and should be carried out by health care professionals and referrals made within the timescales identified in this Policy The assessment is the basis for initiating, developing, maintaining and evaluating the plan of care for an individual with a lower leg wound On going review of the ulcer with a wound assessment should be performed at least monthly but may be required more frequently, depending upon the condition of the wound. 5.5 ULeg Ulcer Clinic Co-Ordinators 6.0 URISK Leg Ulcer Clinic Co-Ordinators will be responsible for ensuring that this Policy is adhered to in Leg Ulcer Clinics Leg Ulcer Clinic Co-Ordinators will be responsible for ensuring the relevant data regarding activity and healing rates is collected from Leg Ulcer Clinics 6.1 Leg ulcer patients do have a risk of tissue damage and deterioration if they are not treated correctly, in extreme cases this has been known to result in limb amputation. The following are risks to patient: ABPI inaccurately measured and calculated Type of ulceration incorrectly identified leading to incorrect treatment Compression bandages incorrectly applied leading to tissue damage Failure to re-assess if ulcer failing to respond to treatment Failure to refer appropriately to other specialists Risk of wound infection due to poor dressing techniques Inappropriately treated wound infection / colonisation Failure to heal due to inappropriate treatment Risk to staff of musculoskeletal injury if manual handling policies are not adhered to and equipment is not available 7.0 UTRAINING 7.1 All staff employed by The Nottinghamshire Healthcare NHS Foundation Trust who have direct contact with and take decisions on the treatment of patients regarding the management of leg ulcers will have access to training on lower leg management. 8.0 UMONITORING COMPLIANCE ISSUE 2 AUGUST

7 EXPERT Lower Leg Wounds Management Compliance with this policy will be monitored by the Tissue Viability Service with the review of electronic patient records data relating to 6 week Doppler recordings 6 week healing rates Clinical Management Plan availability on discharge 9.0 REVIEW DATE 9.1 This policy will be reviewed in 3 years or in light of organisational or legislative changes UEQUALITY IMPACT ASSESSMENT 10.1 Nottinghamshire Healthcare NHS Foundation Trust aims to design services, policies and measures that meet the diverse needs of our services, population and workforce, ensuring that none are placed at a disadvantage over others U WRITER 11.1 The Champion of this policy is Paul Smeeton Chief Operating Executive Health Partnerships. The Expert Writer is Keeley Sheldon Head of Adult Services Bassetlaw UREFERENCES Clinical knowledge Summaries (2012) 19TUhttp://cks.nice.org.uk/leg-ulcer-venousU19T [accessed 08/10/2013] Moffat C, Martin R. and Smithdale, R. (2007) Leg Ulcer Management. Essential clinical skills for nurses. Blackwell Oxford. Morison M, Moffatt, C. and Franks P. (2007) Leg ulcers a problem based learning approach. Mosby. London. RCN Institute (2006) The nursing management of patients with venous leg ulcers. Recommendations (2006) London, Royal College of Nursing SIGN (2010) Management of venous leg ulcers. Edinburgh, Scottish Intercollegiate Guidelines Network, SIGN Publication No. 120 ISSUE 2 AUGUST

8 UAPPENDIX 1 Policy/Procedure for: Lower Leg Wounds Management Issue: 02 Status: Author Name and Title: APPROVED Keeley Sheldon Head of Adult Community Services Issue Date: 30 AUGUST 2016 Review Date: JULY 2019 Approved by: Distribution/Access: PATIENT SAFETY AND EFFECTIVENESS COMMITTEE NORMAL RECORD OF CHANGES DATE AUTHOR POLICY DETAILS OF CHANGE 11/2015 K Sheldon 1.32 Inserted review date, changes to reflect Foundation Trust where applicable, new Trust logo. ISSUE 2 AUGUST

9 EMPLOYEE RECORD OF HAVING READ THE POLICY UAPPENDIX 2 UTitle of Policy/ProcedureU: Lower Leg Wounds Management I have read and understand the principles contained in the named policy/procedure. PRINT FULL NAME SIGNATURE DATE ISSUE 2 AUGUST