Establishment of a 2nd Tier Lower Limb Vascular Clinic, Advanced Nursing Practice, Donegal Public Health Nursing Service.

Rationale: A wound care audit was conducted within the PHN service in 2021. It identified that the Donegal PHN service has a higher wound prevalence 0.25 than the national average 1.  Half of all wounds recorded were lower limb ulceration with only 13 % of patients having a lower limb assessment within 2 weeks. The venous ulceration healing rates was 6% at three months in comparison to 70% internationally 2.  Wound care management was fragmented with no clear referral pathways and /or management strategies.  

Aims and objectives: To develop a tissue viability service within primary care that is clients centered, timely, accessible, and cost effective with clear governance structures. Provide education and training to the PHN services. Develop clear referral pathways for wound management in primary care.

Implementation:

Commencement of ANP academic programme in 2021 with clinical supervisor Prof Walsh. Eligibility criteria, scope of practice and referral pathway to the service launched to the PHN service.

Funding application for specialist equipment (automated Ankle brachial pressure index and Toe Pressure index (TBI) machine) submitted and purchased.

Evaluation/Outcomes

Clients previously attended Galway University Hospital for Toe Brachial Index's- this is now completed at local level.

A wound care formulary was developed in line with the national wound care product framework. This is more cost effective and efficient.

Educational days on wound care were competed with an average of 60% attendance.

Member of the CHO1 pressure ulcer assessment, prevention and management PPPG development.

An audit of pressure ulcer prevalence in the PHN service was conducted in May, 2023. The results showed that Donegal PHN service have 95% less PU at home (0.02) 3 in comparison to international studies 4.

201 clients were seen in 2023 from January till June a 50% increase compared to 2022.  70% of clients with a wound that attended the clinic were healed upon discharge 5.

Conclusion: The evidence demonstrated that the establishment of a tissue viability service improves healing rates, cost effective, accessible and more importantly patient centered.

40% of patients with venous ulceration decline the offer of referral onwards to the tertiary center 5. The vision for the future is to pre-assess clients in Donegal for endovenous ablation in the tertiary center. Offer clients peri ulcer foam sclerotherapy in Donegal which has been shown to improve healing rates.

References

1. Mc Dermott-Scales, L., Cowman, S. and Gethin, G. (2009) Prevalence of wounds in a community care setting in Ireland . Journal of Wound Care, 18,405-17
2. Health Service Executive (HSE). (2018). HSE National Wound Management Guidelines, Dublin, Office of the Nursing & Midwifery Service Director.
3. Public Health Nursing service Donegal (2023) Audit Report of Pressure Ulcer Prevalence in Donegal Public Health Nursing (PHN) Service 2023
4. Guest, J.F., Fuller, G. W., & Vowden, P (2018) venous leg ulcer management in clinical practice in the UK: Cost and outcomes. International Wound Journal, 15(1), 29-37
5. Public Health Nursing service Donegal (2023) Report of the 2nd tier lower limb vascular clinic January- June 2023.