Leg Ulcer care delivered closer to home thanks to collaboration between services

Clinic locations at your local Health Centre by the Public Health Nurse: Thurles, Nenagh, Newport, Roscrea and Borrisokane

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Leg Ulcer care delivered closer to home thanks to collaboration between services

Pictured at UHL are some of the team behind the training and education programme, from left, Niamh Keane, Avril Kenny, Helen Meagher, Fiona Hurley and Pamela Ryan

Community leg ulcer clinics are being expanded across the MidWest thanks to a joint education and training initiative designed by staff from HSE Mid West Community Healthcare and UL Hospitals Group. Integrated care centred around the patient is one of the principal foundations of the Slaintecare Implementation Plan recently published by the Minister for Health. One area where this is already happening in practice in the MidWest is in the management of leg ulcers. This is providing quality, evidence-based care to patients closer to home.

Educational collaboration between community and acute sectors in the MidWest leg ulcer service dates back to 2005. Service development was affected by the financial crisis and the recruitment moratorium. But more recently, the Public Health Nursing Department in Mid West Community Healthcare, in conjunction with the Vascular Department in UHL, began reactivating existing leg ulcer clinics and setting up new clinics in areas of need. To support this process, a programme was designed to upskill public health nurses and RGNs (registered general nurses) to set up and manage leg ulcer clinics in the community in partnership with the vascular consultants and tissue viability nurses at UHL. This would allow patients have timely Doppler (ultrasound)assessments in clinics closer to home and reduce demand on outpatient vascular clinics at UHL.

The new education programme has resulted in a renewed impetus with the opening of four new clinics across the region (Barrack View, Newcastle West, Kilmallock, King’s Island) over the last 12 months. There are 16 such clinics in total across Limerick, Clare and north Tipperary.

A new two-day education programme for community nurses took place in autumn 2017, including a Doppler competency assessment unique to this region. An annual masterclass, the first of which took place in May 2018, has also been established. A total of 35 community nurses participated in the most recent training and education programme. The programme was devised by Helen Meagher, candidate Advanced Nurse Practitioner, Tissue Viability, UL Hospitals Group, and Niamh Keane, Assistant Director of Public Health Nursing; Mid West Community Healthcare; with the support of Consultant Vascular Surgeons Mr Eamonn Kavanagh, Mr Tony Moloney and Prof Paul Burke; Edel Brangan, Community RGN, MSc Tissue Viability; Avril Kenny, Senior Vascular Physiologist, and Fiona Hurley, Centre of Nursing and Midwifery Education.

The project has showcased the importance of interdisciplinary, inter-departmental and integrated acute and community services working together to improve patient care.

It is estimated that approximately one in 100 people will suffer a leg ulcer at some point in their lives. Traditionally, management of leg ulcers required outpatient attendances in an acute hospital but management closer to the patient’s home is increasingly the norm in the MidWest.

A previous study (Brangan 2016) demonstrated that 69% of patients attending the community leg ulcer clinic in Shannon, County Clare, did not need to see a vascular consultant as their ulcer had  healed, thereby avoiding an attendance at a hospital clinic. The same audit found an improvement in patient outcomes with average healing rates having reduced from 20-40 weeks to 8-12 weeks. It is hoped that through the ongoing training programme, patients will get complete care closer to home and outcomes will continue to improve.

“This is an important service for patients, allowing them to access evidence-based leg ulcer care in their community environment. The leg ulcer clinics have a direct referral pathway to vascular outpatients, if required. This results in more appropriate use of vascular OPD appointments,” said Ms Meagher.

Ms Keane explained: “This integration and expansion of our MidWest community leg ulcer clinics  results from developing and fostering  working relationships between the services. The leg ulcer service is very much patient-centred  and the development of our service aims to improve clinical care and meet patient needs. Staff have a great passion for their work. Community nurses who completed the education and training programmes have developed a clinical skill and competency in leg ulcer management, directly impacting on service delivery.

Prof Colette Cowan, CEO, UL Hospitals Group said: “This is another example of the strong working relationship between UL Hospitals and Mid West Community Healthcare. The Slaintecare Implementation Plan sets out the fact that Hospital Groups and Community Healthcare Organisations in Ireland are, for the most part, not geographically aligned and that this impedes the kind of integrated planning and care delivery envisaged by Slaintecare. We are fortunate in the MidWest that our acute and community services are geographically coterminous and we don’t suffer from such impediments as much.

“Patient-centred care involves breaking down that silo mentality that can operate within any large organisation. In the MidWest, we already do this. That is down to our people as much as any accident of geography and the teams behind the development of community leg ulcer clinics are tremendous examples of this. Other examples where we continue to make progress include the community intervention teams providing antibiotics and other basic care in a patient’s home or care facility; our recently established perinatal mental health service and the expansion of community midwifery.

Kate Duggan, Head of Primary Care, HSE Mid West Community Healthcare, commented: “This integrated service is a significantly positive development in the delivery of high quality services in the community, as close to a patient’s home as possible. It is the initiative, commitment and professionalism of our nursing staff that has enabled the implementation of this service, and I know that patients and their families across the Mid-West will have a positive experience of this service.” 

Clinic locations at your local Health Centre by the Public Health Nurse are as follows: Newcastle West; Thurles; King’s Island; Roxtown; Ennis; Shannon; Ennistymon; Scarriff; Barrack View; Nenagh; Kilmallock; Kilrush; Milford; Newport, Roscrea and Borrisokane.