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Developing a 'Silver Standard' pathway to improve Leg Ulcer management in Care Homes

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DEVELOPING A ‘SILVER STANDARD’ PATHWAY TO IMPROVE LEG ULCER MANAGEMENT IN CARE HOMESDEVELOPING A ‘SILVER STANDARD’ PATHWAY TO IMPROVE LEG ULCER MANAGEMENT IN CARE HOMES

INTRODUCTION
Leg ulcer is a condition that mainly affects older people. However, recent evidences by Anderson
(2009) and Moffatt (2001) claimed that it can occur in all ages specifically to those with increasing
risk factors such as: history of varicose veins, DVT, hypertension, obesity and hereditary.
As identified by RCN (2006), there are 2 main types of leg ulcers: venous and arterial and due
to their underlying pathology, each type will require a specific intervention to manage them
appropriately. Venous leg ulcers are the most common type of Leg ulcers hence accounting for
approx. 40-85% of patients diagnosed (Harding K et al 2015). RCN (2006) further stated that the
Gold Standard treatment to venous leg ulcer (VLU) is compression therapy following successful
Doppler and holistic assessment.
Unfortunately in care homes, qualified nurses do not have access to specialist courses to
acquire these knowledge and skills, hence refer to Tissue Viability for further assessment
and follow up. Previously, following a holistic assessment, TVN will only recommend simple
bandaging using 2 layer bandaging to manage these patients as the staff in care homes are not
trained to provide specialist bandaging to the patients.
Having identified the increased need of training in care homes following increased number of
referrals for patients with VLU, the TV team has identified a potential break through to bridge the
gaps in practice where patient can receive appropriate bandaging and staff can safely apply them
while practising within their limitation. Hence a ‘Silver Standard’ pathway (Hedger and Connolly
2014) has been designed and adopted for implementation in care homes to improve healing rates
and patient quality of care while at the same time reduce nursing time and cost.
METHOD
Develop a pathway for assessment and management of leg ulcer for care home nurses to follow.
In the absence of arterial disease, care home staff to start The aim of designing this framework/ pathway is to silver standard treatment to our patients with VLU where gold standard treatment recommended by RCN is not suitable. Bandages used will be URGO K-Soft single layer and URGO K-Lite two layers, which in total will 17mmHg to patient’s legs equivalent to a Class 1 British standard Hosiery.

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