TY  - INPR
T1  - CLINICAL PATHWAY AS A TOOL FOR WOUND MANAGEMENT OF PATIENTS WITH VENOUS LEG ULCERS
T5  - Poster presented at WUWHS 2004
LA  - English
AU  - Polignano, R.
AU  - Andriessen, Anneke
AU  - Abel, Martin
AU  - Zimpfer, F.
AB  - INTRODUCTION
Complex wounds may cause a dependence of patients on professional care for a longer period than necessary. Healthcare reflects an interest in linear continuity. Leg ulceration is tissue breakdown that occurs in already damaged skin, it is a common condition with a prevalence between 1.5 and 3 per 1000. Various studies on leg ulceration show that approximately 90% of causes for ulceration of the lower limb are of venous -, i.e. venous-lymphatic origin. As age progresses mixed venous-arterial forms become more frequent, especially in connection with diabetes mellitus. About 6% of the causes for leg ulcerations are of arterial origin, the remaining circa 4% are divided over the other groups. Leg ulcers are considered chronic, when it takes more than six weeks to close them. Most patients are managed in primary - care, community nurses spend a considerable amount of their time managing leg ulcers patients. It is recognised that the most important factor in treating venous leg ulcers is the application of effective sustained compression. A venous ulcer will fail or be slow to heal without the application of sustained graduated compression. Studies have shown a strong correlation between the duration of the ulcer and the time it takes to healing the ulcer. Large size ulcers (circumferential ulcers) were reported to take longer to heal than small ulcers (< 4cm2). Many of the bandages traditionally used to treat patients with venous leg ulceration, are ineffective due to lack of technique and practice by persons applying the bandage. For the application of short stretch bandages different application techniques are in use. A commonly used technique is the application of 2 bandages of 8- and 10 cm width, starting at the foot. The system is reapplied when clinically required at the discretion of the care giver, by the patient/family or nurse. The bandages are washed and reused up to 6 times.

MATERIAL AND METHODS
This paper gives a report of the development and validation of a clinical pathway for patients with venous leg ulcers. The evidence based clinical pathway (box I) and applicable products* (box II and III), were tested by using case ascertainment.
The purpose of this study is to evaluate a clinical pathway, applied for patients with venous leg ulceration, looking at the performance of the compression system used and the dressings applied. Before recruitment to the study patients were assessed using a standard procedure which includes the measurement of ankle brachial pressure indices (ABPI) and Doppler, to determine whether the patient is suffering from significant peripheral arterial disease. If applicable, further diagnostics, using Duplex Sonography, phlebography and DPPG were performed. In-patients and/or out-patients at the trial centre are recruited to the study. The number of patients in this study (N = 10) was not based on a statistical consideration. Patients are treated applying the clinical pathway on an intention to treat basis, with the short stretch bandage system (Rosidal® Sys) and a wound dressing from the Suprasorb® range. The clinical Investigator sought permission of the relevant consultant for their patients and of the patient to be included in the study. A standardized questionnaire is used for this clinical evaluation. Identified patients were clinically examined to determine general condition, associated factors, wound type, stage, wound evolution, quality of life aspects, efficacy of treatment, costs efficacy (focussing costs of treatment as well as time investment of staff) etc. Clinical examination was performed, depending on wound type, upon initial assessment and at 2 week intervals. The evaluation included structured interviews on how wound management was carried out, before implementing the clinical pathway. Available outcome of the centre on the treatment of patients with venous leg ulcers was used as a baseline.
For each individual patient, the clinical evaluation observation period was 12 weeks. The patient record form booklet was completed for one wound only. The number of patients that were withdrawn from the study, of which the ulcer had not healed were listed in full, as well as adverse incidents, whether bandage related or otherwise.

RESULTS
The interim results demonstrated an improvement of quality of care, cost savings and moreover an improved level of knowledge and communication between the clinicians involved in the care of patients with venous leg ulcers.

CONCLUSIONS
Communal knowledge and effort can be tuned to the interest of patients, institutions and commercial parties. Clinical pathways applied throughout the complete care chain, supports improvement of quality of care.
CY  - Paris, France
Y2  - 1089237600
ER  -