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

Melanie Thomas National clinical lead for lymphoedema, Wales, Lymphoedema Network Wales, Cimla Hospital, West Glamorgan, Wales
Karen Morgan National lymphoedema research and education lead, Lymphoedema Network Wales, Cimla Hospital, West Glamorgan, Wales
Ioan Humphreys Researcher, Swansea University, Swansea, Wales
Diane Jehu Lymphoedema community specialist, Lymphoedema Network Wales, Cimla Hospital, West Glamorgan, Wales
Linda Jenkins Lymphoedema community specialist, Lymphoedema Network Wales, Cimla Hospital, West Glamorgan, Wales

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 NHS, and improve the quality of life of patients with chronic oedema and wet legs.

Correspondence melanie.j.thomas@wales.nhs.uk   @Lymphwales

Nursing Standard. 32, 11,39-50. doi: 10.7748/ns.2017.e10951

Received: 15 July 2017

Accepted: 21 September 2017

Published in print: 08 November 2017

Peer review

This article has been subject to external double-blind peer review and checked for plagiarism using automated software

Conflict Of Interest

None declared