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Reducing HCAIs
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TOPIC: Re: What's the cost of Leg Ulcer?

Re: What's the cost of Leg Ulcer? 9 months, 2 weeks ago #1

About 1–2% of the whole population and 3–5% of the population over 65 years of age will suffer from a leg ulcer during their lifetime. The prevalence of the population at age 80 years is about20 per 1,000. Venous leg ulcers (VLU) pose a serious clinical dilemma as well as a large economic burden on health services. The annual cost was estimated to be between £400m and £600m in the UK. The average cost of treating one VLU has been reported to vary between £546–£1,338 in the UK.Whilst healing may not always be a clinical objective, it is reasonable to assume that it is the aim of most clinicians and patients. Recent evidence suggests that 12 week healing is approx 50% under clinical trial conditions. It is my firm belief that current rates, averaged out in the community, are far below this level.
What do patients need for ‘quality care’ of their leg ulcer:
• A standard of care which includes the following essential components:o Accurate assessment of aetiology.o Skin care on the limb.o Management of wound infection.o Management of wound-related pain.o Wound debridement.o Rapid referral pathways for vascular and dermatological assessment.o Leg washing.o Continuity of care.o Education and information.o Involvement in the care, so improving concordance.
The problem as I have seen it in my personal experience as an educator and researcher is as follows:
• Community nursing staff claim to have insufficient time to deliver standard care.• Dressings and bandages necessary for such care are not always readily available.• Nurses’ knowledge is often very poor and out of date. Budgetary cuts and freezes on training were associated with an ignorance of guidelines.• Referrals for vascular assessments are not considered, or are delayed for far too long.• Referrals to dermatology (for suspected allergic contact dermatitis) rarely happen.
These are my views. What are yours?

Re: What's the cost of Leg Ulcer? 9 months, 2 weeks ago #2

I think if nurses are given the right training and support and are in good numbers, they can deliver a good service. Every nurse wants to do good and not cause harm to a patient. But the way things are with cuts, shortages and little training, we can not expect miracles from the few tired nureses. On the other hand GPs are asked to sort issues out and try not to refer. So patients are pushed back for longer periods than necessary, causing their legs to worsen. To me it's all down to govt budgets. Govt should put more money to NHS so that people can save lives and enjoy good quality of health.

Re: What's the cost of Leg Ulcer? 9 months, 2 weeks ago #3

Whilst I agree with Prof White's quality standard needs I have a slightly diffrent view on some of the specific reasons for slow/poor healing rates. We could all always do with more of everything, but I think it is too easy to relate all problems to a shortage of something, be it nurses, time or funding . From my experience, I think there are several quite simple reasons that could be overcome with little, if any financial implications.
Although one cannot under estimate the importance of peer support, regular updates and training.Despite having compression therapy, too many patients do not have therapuetic compression applied. It seems this is due to a couple of reasons.

A) Nurses will often start patients with reduced compression when ABPI indicates "full" compression ie 40mmHg at the ankle, is quite safe to apply. They mean well and say they will advance to full compression if the patient can tolerate reduced. Perhaps the nurses do not have full confidence in their ability to apply compression and err on the side of caution so as not to harm their patients. Perhaps the patient is reluctant to more to a higher compression. In reality this results in a large number of patients who never progress to therapuetic compression and devlop an aversion to the top cohesive layer. I think nures really have to introduce compression therapy in positive light, emphasising why and how it works

B) Too often, many nurses use a one size fits all bandage regime and don't fully take into account the size and shape of the limb, again resulting in a non therapuetic compression system.
Ankle and calf circumference is not measured often enough.

C) Too many bandages are poorly applied and patients can and do develop grossly mishapen limbs, making it even more difficult to maintain therapuetic compression.

D) Compression therapy is stopped before ulcers are fully healed.

For patients who are not making good progress towards healing, referral to secondary care is important to identify problems and to treat varicose veins surgery appropriate. However, quite often in secondary care all we need to do is to provide simple, consitent, therapuetic compression, that fully takes into account the size and shape of patients limbs.
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