Using a health improvement methodology to standardise leg ulcer management

2020 ◽  
Vol 25 (Sup9) ◽  
pp. S20-S25
Author(s):  
Kirsten Mahoney ◽  
Wendy Simmonds
Keyword(s):  
Clinical Practice ◽  
Patient Outcomes ◽  
Best Practice ◽  
Leg Ulcer ◽  
Health Improvement ◽  
Evidence Based ◽  
Leg Ulcers ◽  
Venous Leg Ulcers ◽  
Poor Patient ◽  
Pdsa Cycle

Despite guidelines, best-practice statements and CQUIN targets, venous leg ulcers have been highlighted as an area that continues to demonstrate lack of evidence-based practice and variation in practice, which contribute to poor patient outcomes and escalating costs. Leg ulcer services that use a systematic and standardised approach to leg ulcer management are highly successful in improving healing rates, preventing recurrence and contributing to patients' wellbeing. This article seeks to explore the use of the plan-do-study-act (PDSA) cycle in clinical practice to improve and standardise leg ulcer management.

Embedding National Institute for Health and Care Excellence guidance into a leg ulcer pathway

2019 ◽  
Vol 24 (Sup9) ◽  
pp. S6-S11
Author(s):  
Julie Mullings
Keyword(s):  
Chronic Wounds ◽  
Wound Care ◽  
Compression Therapy ◽  
Leg Ulcer ◽  
Evidence Based ◽  
Leg Ulcers ◽  
Correct Treatment ◽  
Treatment Choices ◽  
Venous Leg Ulcers ◽  
The Uk

Research has shown that leg ulcers represent the largest category of wound type treated within the UK. Venous leg ulcers are often classified as chronic wounds with increased protease levels causing the wound to become suspended in the inflammatory stage, which leads to delayed healing. If treatment choices are not evidence-based and appropriate regimens are not instigated early on in the wound care journey, the cost to both the patient and the healthcare service is substantial. Recent guidance from the National Institute of Health and Care Excellence (NICE) recommends UrgoStart (Urgo Medical) for treating venous leg ulcers as an adjunct therapy to the gold standard of compression therapy. Correct treatment choices must be made by clinicians using up-to-date relevant wound care knowledge. Evidence-based treatment algorithms and pathways can assist with correct product and therapy placement, assisting decision-making to improve patient outcomes. The present article describes a patient-centred leg ulcer pathway that embeds NICE guidance.

Meeting the Best Practice for Hearing Aid Verification in Children: Challenges and Future Directions

2019 ◽  
Vol 28 (4) ◽  
pp. 877-894
Author(s):  
Nur Azyani Amri ◽  
Tian Kar Quar ◽  
Foong Yen Chong
Keyword(s):  
Clinical Practice ◽  
Hearing Aids ◽  
Best Practice ◽  
Hearing Aid ◽  
Evidence Based ◽  
Future Directions ◽  
Major Barrier ◽  
Klang Valley ◽  
Age Range ◽  
Fitting Hearing Aids

Purpose This study examined the current pediatric amplification practice with an emphasis on hearing aid verification using probe microphone measurement (PMM), among audiologists in Klang Valley, Malaysia. Frequency of practice, access to PMM system, practiced protocols, barriers, and perception toward the benefits of PMM were identified through a survey. Method A questionnaire was distributed to and filled in by the audiologists who provided pediatric amplification service in Klang Valley, Malaysia. One hundred eight ( N = 108) audiologists, composed of 90.3% women and 9.7% men (age range: 23–48 years), participated in the survey. Results PMM was not a clinical routine practiced by a majority of the audiologists, despite its recognition as the best clinical practice that should be incorporated into protocols for fitting hearing aids in children. Variations in practice existed warranting further steps to improve the current practice for children with hearing impairment. The lack of access to PMM equipment was 1 major barrier for the audiologists to practice real-ear verification. Practitioners' characteristics such as time constraints, low confidence, and knowledge levels were also identified as barriers that impede the uptake of the evidence-based practice. Conclusions The implementation of PMM in clinical practice remains a challenge to the audiology profession. A knowledge-transfer approach that takes into consideration the barriers and involves effective collaboration or engagement between the knowledge providers and potential stakeholders is required to promote the clinical application of evidence-based best practice.

Updated leg ulcer pathway: improving healing times and reducing costs

2019 ◽  
Vol 28 (20) ◽  
pp. S21-S26
Author(s):  
Leanne Atkin ◽  
Alison Schofield ◽  
Anita Kilroy-Findley
Keyword(s):  
Quality Of Life ◽  
Leg Ulcer ◽  
Leg Ulcers ◽  
Nursing Time ◽  
Venous Leg Ulcers ◽  
Reduced Costs ◽  
Reducing Costs

Regardless of the amount of literature and evidence on leg ulcer management, there are still significant variations in treatment. Implementing a standardised leg ulcer pathway to ensure patients are appropriately and timely assessed could help reduce nursing time and overall costs, while improving healing outcomes and patients' quality of life. Such a pathway was introduced in Lincolnshire and Leicestershire, UK, to treat venous leg ulcers (VLUs). The results showed improved healing times, reduced costs and fewer nurse visits, among other findings.

Management of Patients With Venous Leg Ulcers: Challenges and Current Best Practice

2016 ◽  
Vol 25 (Sup6) ◽  
pp. S1-S67 ◽  
Author(s):  
Peter J Franks ◽  
Judith Barker ◽  
Mark Collier ◽  
Georgina Gethin ◽  
Emily Haesler ◽  
...  
Keyword(s):  
Best Practice ◽  
Leg Ulcers ◽  
Venous Leg Ulcers

The implementation of clinical practice guidelines for venous leg ulcers

1999 ◽  
Vol 14 (12) ◽  
pp. 63-68 ◽  
Author(s):  
Aciare Morrell ◽  
Hui Liao MBchb ◽  
Gill Harvey
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Leg Ulcers ◽  
Venous Leg Ulcers

Controlling compression bandaging pressure in leg ulcer research trials: A summary of the literature

2019 ◽  
Vol 34 (8) ◽  
pp. 501-514 ◽  
Author(s):  
Sharon L Boxall ◽  
Keryln Carville ◽  
Gavin D Leslie ◽  
Shirley J Jansen
Keyword(s):  
Ulcer Healing ◽  
Gold Standard ◽  
Reliability And Validity ◽  
Leg Ulcer ◽  
Evidence Based ◽  
Leg Ulcers ◽  
Venous Leg Ulcer ◽  
Practice Recommendations ◽  
Compression Bandaging ◽  
Literature Searches

Compression bandaging remains the ‘gold standard’ intervention for the treatment of venous leg ulcers. Numerous studies have investigated the effect of a large variety of compression bandaging techniques and materials on venous leg ulcer healing. However, the majority of these studies failed to monitor both actual bandage application pressures and the bandaging competency of participating clinicians. A series of literature searches to explore the methods, practices, recommendations and results of monitoring compression bandaging pressures in leg ulcer research trials were undertaken. This included investigating the reliability and validity of sub-bandage pressure monitors and the degree to which compression bandaging achieves the recommended sub-bandage pressure. The literature revealed inconsistencies regarding the monitoring of sub-bandage pressure and in sub-bandage pressures produced by clinicians. This creates difficulties when comparing study outcomes and attempting to develop evidence-based practice recommendations.

Clinical interventions for venous leg ulcers: Proposals to improve the quality of clinical leg ulcer research

2016 ◽  
Vol 24 (5) ◽  
pp. 767-774 ◽  
Author(s):  
Gerald S. Lazarus ◽  
Robert S. Kirsner ◽  
Jonathan Zenilman ◽  
M. Frances Valle ◽  
David J. Margolis ◽  
...  
Keyword(s):  
Leg Ulcer ◽  
Leg Ulcers ◽  
Clinical Interventions ◽  
Venous Leg Ulcers

Best Practice Recommendations for the Prevention and Treatment of Venous Leg Ulcers

2007 ◽  
Vol 20 (11) ◽  
pp. 611-621 ◽  
Author(s):  
Cathy Burrows ◽  
Rob Miller ◽  
Debbie Townsend ◽  
Ritchie Bellefontaine ◽  
Gerald MacKean ◽  
...  
Keyword(s):  
Best Practice ◽  
Leg Ulcers ◽  
Venous Leg Ulcers ◽  
Practice Recommendations ◽  
Prevention And Treatment

Pediatric Audiology in North America: Current Clinical Practice and How It Relates to the American Academy of Audiology Pediatric Amplification Guideline

2016 ◽  
Vol 27 (03) ◽  
pp. 166-187 ◽  
Author(s):  
Sheila Moodie ◽  
Eileen Rall ◽  
Leisha Eiten ◽  
George Lindley ◽  
Dave Gordey ◽  
...  
Keyword(s):  
Clinical Practice ◽  
North America ◽  
Data Collection ◽  
Practice Guidelines ◽  
Best Practice ◽  
Intervention Program ◽  
Hearing Aid ◽  
Evidence Based ◽  
Pediatric Audiology ◽  
Family Centered

Background: There is broad consensus that screening and diagnosis of permanent hearing loss in children must be embedded within a comprehensive, evidence-based, family-centered intervention program. Clinical practice guidelines (CPGs) for pediatric hearing assessment and hearing aid verification aim to reduce variability in practice and increase the use of effective evidence-based diagnostic and treatment options so that optimal outcomes may be achieved. To be of value, guidelines must be translated and implemented into practice and ongoing monitoring of their use in practice should occur. Purpose: This paper provides the results of two studies that aim to examine current pediatric audiology and amplification practice in North America. Research Design: A concurrent embedded mixed methods design was used. Study Sample: An electronic survey was distributed to North American audiologists who delivered pediatric audiology services with 350 audiologists participating in study 1 and 63 audiologists participating in study 2. Data Collection and Analysis: A quantitative approach was the predominant method of data collection. Respondents were prompted to provide additional qualitative text and detail regarding their quantitative response choice. This qualitative text was used during the analysis phase and combined with quantitative results to assist understanding of respondents’ knowledge, skills, and barriers/facilitators to implement best practice in pediatric amplification. Results: Approximately 70% of audiologists reported using best-practice protocols for pediatric hearing aid fitting. Despite widespread knowledge and increased use of CPGs over the last 18 yrs, results of these studies show that variation in practice patterns continue to exist. Several examples of implementation challenges are discussed with recommendations provided. Conclusions: In order for audiologists working with children who are deaf or hard of hearing and their families to achieve the principles of family-centered early intervention, practice guidelines must continue to be developed, disseminated, and translated as they have a positive impact on the services provided. Researchers and clinical audiologists who deliver services must continue to collaborate to understand the “how” and “why” of implementing guidelines into practice and to identify the barriers/facilitators encountered in trying to do so.

Frequency of Isolated Superficial Venous Incompetence in Patients with Venous Ulcers as Measured by Ambulatory Strain-Gauge Plethysmography

1995 ◽  
Vol 10 (2) ◽  
pp. 65-68 ◽  
Author(s):  
C. Hansson ◽  
J. Holm
Keyword(s):  
Strain Gauge ◽  
Screening Method ◽  
Leg Ulcer ◽  
Leg Ulcers ◽  
Pressure Measurements ◽  
Venous Leg Ulcer ◽  
Venous Ulceration ◽  
Venous Leg Ulcers ◽  
Strain Gauge Plethysmography ◽  
Venous Ulcers

Objective: Identification of isolated superficial venous incompetence (SVI) in patients with clinically diagnosed venous leg ulcers using a computerized strain-gauge plethysmograph. Design: Ambulatory leg ulcer patients were assessed as to the clinical diagnosis. Diagnoses other than venous ulceration were excluded. Setting: Department of Dermatology, Sahlgrenska Hospital, Göteborg, Sweden. Patients: One hundred and fourteen patients (133 legs) with venous leg ulcers were investigated. Main outcome measures: All patients were also investigated by measuring systolic ankle and arm pressure measurements. The ankle/arm (AI) was below 0.9 in 22 of the 133 ulcerated legs. Results: Of the 111 ulcerated legs with an AI>0.9, 10% had an isolated SVI. Conclusions: Isolated SVI is an important cause of venous leg ulcer development. Strain-gauge plethysmography is an inexpensive screening method, and is easy to use. Further examination with the more exact, but also more expensive and time-consuming, colour duplex should be performed in selected cases.

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