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So much more than a wound Editor Rowan Dennison Sub-editor Peter Bradley Associate Publisher Julie Smith Publishing Director Anthony Kerr Managing Director Jon Benson

Editorial board Annemarie Brown Independent Tissue Viability Consultant June Jones Independent Tissue Viability Consultant Fiona Collins Director, National Wound Healing Centres Lee Yarwood-Ross Lecturer, Manchester Metropolitan University

MA Healthcare Ltd is part of the Mark Allen Group

www.markallengroup.com The British Journal of Community Nursing is published by MA Healthcare Ltd, St Jude’s Church, Dulwich Road, London SE24 0PB Tel: +44 (0)20 7738 5454 Website: www.bjcn.co.uk © MA Healthcare Ltd, 2014. All rights reserved. No part of the British Journal of Community Nursing or Community Wound Care may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the Publishing Director. ISSN 1462-4753 Printed by Pensord Press Ltd, Blackwood, NP12 2YA

The paper used within this publication has been sourced from Chain-of-Custody certified manufacturers, operating within international environmental standards, to ensure sustainable sourcing of the raw materials, sustainable production and to minimise our carbon footprint. Cover image: billyfoto/iStock

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have been involved in the management of patients with leg ulceration in various guises since I started district nursing in 1985. At that time there was very little understanding of leg ulceration in the nursing world, only a very limited range of wound care products was available and the use of compression therapy was not common practice. Times have changed, clinical practice has developed and our knowledge and skills have improved. The emphasis in leg ulcer management today is on undertaking an in-depth assessment to diagnose the underlying pathophysiology, and to treat or manage the underlying disease process—a leg ulcer is so much more than a wound. The management of patients with leg ulceration varies across all care settings.There is no national standard to ensure the provision of optimal, evidence-based care. Evidence suggests that the most common underlying cause of leg ulceration is venous disease, yet a venous duplex ultrasound is not routinely undertaken as part of the assessment.This procedure is generally only available where vascular services are involved in the care of the patient.The current assessment process concentrates on the exclusion of arterial disease to ensure that compression therapy can be safely applied. As there is evidence to support that the correction of underlying superficial venous disease reduces the risk of ulcer recurrence and may potentially contribute to ulcer healing (Ghauri and Nyamekye, 2010), it would seem logical for the assessment process to include a duplex scan. Recent guidelines from the National Institute for Health and Care Excellence (NICE) (2013) advise that patients with leg ulceration of longer than 2 weeks’ duration should be referred to a vascular team for assessment including a venous duplex scan. In this new era of care provision, leg ulcer assessment and management can be provided by Any Qualified Provider (Department of Health (DH), 2011).This has the potential to offer greater choice for the patient, but one has to consider whether the patient will be able to access all components of a full and comprehensive assessment.The advice from the DH to manage patients with chronic conditions in primary care contradicts the NICE guidance and may cause dilemmas for clinicians. Patient choice is often referred to in DH documents, but do we really consider the patient’s view? Patients I have the privilege to meet tell me that what they really want is prompt assessment and appropriate treatment, and to be cared for by someone who has the knowledge and skills to heal the ulcer. The remit of clinical commissioning groups is to develop local services to meet the needs of the local population.This is an opportunity to ensure that services work together to provide the best person for the job and to ensure that patients with leg ulceration receive an assessment that will identify the pathophysiology of their ulceration.The education of the workforce should not be ignored—knowledge, skills and competence are, of course, the key to successful management. Julie Day Clinical Nurse Specialist, Leg Ulcers, Worcestershire Acute Hospitals NHS Trust and Lecturer, University of Worcester Department of Health (2011) Operational Guidance to the NHS: Extending Patient Choice of Provider. http://tinyurl.com/o9rnd6c (accessed 19 June 2014) Ghauri ASK, Nyamekye IK (2010) Leg ulceration: the importance of treating the underlying pathophysiology. Phlebology 25(Suppl 1): 42–51 National Institute for Health and Care Excellence (2013) Varicose Veins in the Legs. Clinical guideline 168. http://tinyurl.com/np3joz2 (accessed 19 June 2014)

Community Wound Care September 2014 h Journal of Community Nursing. Downloaded from magonlinelibrary.com by 193.061.135.112 on November 6, 2015. For personal use only. No other uses without permission. . All rights res

So much more than a wound.

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