Managing chronic oedema and wet legs in the community: a service evaluation

Thomas M, Morgan K, Humphreys I et al (2017). Nursing Standard, volume 32 number 11 / 8 November 2017

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Managing chronic oedema and wet legs in the community: a service evaluation

Thomas M, Morgan K, Humphreys I et al (2017). Nursing Standard, volume 32 number 11 /  8 November 2017

Patients with chronic oedema and ‘wet legs’ are frequently seen in the community setting, with research indicating that more than half of community nurses’ caseloads are patients with chronic oedema. However, a lack of nurse education and standardised care pathways for this condition has been identified. In June 2016, the Welsh Government supported the development of the On the Ground Education Project (OGEP), which aimed to raise community nurses’ awareness and recognition of chronic oedema and wet legs, to improve the management of these conditions, and to support the efficient use of community nurses’ time and resources.

Aim To investigate the potential economic benefits of the OGEP and its effects on patients’ quality of life.

Method The OGEP was implemented between June 2016 and March 2017. During this time, 725 patients were assessed and chronic oedema was diagnosed in 426 (59%) of them. Of these, 100 patients were purposively recruited and 97 completed the pilot service evaluation. Data were collected observationally before and after the OGEP was implemented. Baseline measurements of resources, costs and outcomes were captured at the time the patients were initially identified and at a follow-up review three months later. The EQ-5D-5L tool was used to measure patients’ health-related quality of life before and after the OGEP was implemented. Data were analysed using Microsoft Excel and SPSS Version 22.

Results Following implementation of the OGEP, there was a significant decrease in the number of district nurse home visits, (P=<0.001), GP surgery appointments (P=0.003) and episodes of cellulitis (P=<0.001). The EQ-5D-5L utility scores showed that patients’ quality of life improved after the OGEP was implemented, from a baseline of 0.401 (SD 0.254) to 0.537 (SD 0.231) at the three-month follow-up review.

Conclusion The OGEP may support the efficient use of community nurses’ time and resources, reduce costs to the

Main findings

  • Chronic oedema and wet legs are frequently encountered in the community setting (For-Szabo and Ralph 2017.
  • According to Moffatt (2017), up to 69% of community nurses’ caseloads are patients who have chronic oedema.
  • There is limited national guidance on the management of chronic oedema and wet legs in the community.
  • Welsh Government supported the development of the On the Ground Education Project (OGEP) through its health technologies and telehealth fund. The aim of the OGEP was to raise staff awareness and recognition of chronic oedema and wet legs, to improve the management of these conditions and support the efficient use of community nurses’ time and resources.
  • The OGEP consisted of one lymphoedema clinical educator working daily with a Cardiff and Vale community nurse for at least three days, identifying patients with chronic oedema and those at risk of developing the condition, and implementing best practice evidence-based management intervention.
  • Management interventions implemented in the OGEP included:
    • Skin care
    • Movement and exercise
    • General advice on sleeping arrangements
    • Compression via the “Wet Leg Pathway” which is a compression guide
    • Cellulitis
    • Fungal infections
  • Results The OGEP commenced in June 2016 and was completed in March 2017. A total of 725 patients were assessed jointly by the lymphoedema clinical educators and community nurses during the study period. Chronic oedema was diagnosed in 426 (59%) of these patients. Of these 426 patients with chronic oedema.
  • 97 participants were included in the data analysis. Of these, 63 (65%) were female and 34 (35%) were male, and their ages ranged from 41-99 years, with a mean age of 83 years.
  • The results indicate there were changes in the use of resources and costs between the baseline and three-month follow-up review after the OGEP was implemented. There were reductions in the number of district nurse home visits, number of episodes of cellulitis and dressing costs. The pilot service evaluation also indicated there were small but important patient health gains in quality of life seen at the three-month follow-up review, compared with the baseline.