Multidisciplinary Approach to the Management of Chronic Oedema in
Primary Care
Leg oedema is often a precursor for developing venous leg ulcers, cellulitis and lymphoedema.
Compression hosiery has an important role to play in the prevention of these conditions. This project
aims to develop a community care model to manage patients in primary care through assessment
and review aiming to:
• Reduce and/or address the variation in prescribing of compression
hosiery
• Improve the care of patients in compression hosiery
• Prevent the development of venous ulceration and associated
conditions
• Reduce hospital admissions and antibiotic prescribing costs due to
cellulitis.
The project is now in its third year, offering to work with all GP Practices
in the Trust to provide support and education in the early assessment and
management of simple chronic oedema.
In a multidisciplinary collaborative approach, the Tissue Viability and Lymphoedema services jointly
developed a model of care initiating practice-based clinics to identify and manage simple early
oedema.
A Chronic Oedema Nurse has been appointed to further develop the model and implement its use
throughout the practices, supporting the staff on an on-going basis. Over 350 service users have
been assessed and educated in the clinics based in 29 GP Practices Trust wide.
The project has continued to develop and grow since its inception in 2017, using quality improvement
methodology - PDSA cycles to review and adapt and improve systems and data collection. Adaptation
of systems is required dependent upon each computer system used as there are variances within
practices.
A comprehensive system and model is now easily implemented once a practice agrees to participate.
More than 350 patients have been assessed through the project in 29 practices running clinics Trust
wide.
The achievements to date are positive, with excellent patient feedback, patient and staff education
and a reduction in ineffective diuretic and antibiotics the most notable.
Dissemination of the learning and achievements of the project
has commenced with an oral presentation of the project
delivered by Pippa McCabe in Chicago June 2019 at the
International Lymphoedema Forum conference and was very
well received. The project also reached the finals of SET
Chairman's Awards 2019, placing runner up in a very strong
category.
Vivienne Murdoch (Chronic Oedema Nurse) was runner-up in
the British Journal of Nursing, Chronic Oedema Nurse of the
Year, in London in March 2019, for her work in the implementation of the Practice-Based Healthy
Leg Project. Her work has been published in the British Journal of Nursing and British Journal of
Community Nursing in 2019, with further publication in the Journal of General Practice Nursing
expected in September 2020.
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Goal 5: Integrating the Care - Community Care