1. Complex Leg Wound Service - Preventing Leg Ulcers
Sophie Dela Cruz

2. Who we are
The CCG carried out an audit of practice which identified an inequality in leg ulcer care across localities and GP practices in Gloucestershire.
The previous Leg Ulcer Management Pathway was not meeting the needs of the whole population and has led to both inappropriate referrals to the Acute Hospital Leg Ulcer Service and Admissions. There was also no pathway for Chronic Oedema Management.
The estimated Gloucestershire CCG spend on Primary Non Elective Admission into Secondary Care with Ulcers of Lower Limb as Primary or Secondary diagnosis was estimated at £1.8 Million in 2013/14 (HES Data 2014). Combined with Cellulitis admissions - estimated costs nearly £4Million.

3. New model

4. Patient journey

5. Following initial assessment with the specialist nurse, patient signposted to simple or complex pathway as per service specification.
Following assessment a management plan is formulated with the patient and the nurse, with consideration of the patients co-morbidities, social circumstances and expectations.
For VERY SIMPLE venous ulcers a treatment plan is shared with the patient and GP/practice nurse who will continue to deliver that care

6. Advantages

7. Identifying problems that may lead to leg ulcers

8. Predisposing factors Smoking Obesity Post surgery Previous DVT
Major orthopaedic surgery (THR/TKR)
Trauma to the leg
Pregnancy
Varicose veins
Mobility problems
IVDU
Diabetes

9. A venous ulcer is the manifestation of the underlying
Prevention is better than cure
A venous ulcer is the manifestation of the underlying
disease process.
It is important to understand that leg ulcers don’t just appear and they are caused by an underlying problem that could have been ignored for months and months.
Understanding and identifying potential problem in someone's legs could prevent them developing an ulcer later on and prevent all the pain, psychological problems and social problems that having an ulcer can bring.

10. Identifying skin changes

11. Patient perspective of service