Julie Green

Leg ulcer consultation template (LUCT)

Background

A four-stage empirical research project, completed in 2014, culminated in the development of a quality of life consultation template (LUCT) for use with patients with chronic venous leg ulcers (CVLU), to focus the consultation on person-centred needs and their quality of life.

The study revealed that during unstructured interviews, participants openly spoke of the devastating impact of their wounds; speaking of pain, odour, exudate, social isolation and recurrence. Despite such open and frank disclosure, observed consultations with the same participants and their nurses revealed a lack of disclosure of those same themes, with, in some cases, participants saying they were comfortable, despite disclosing at interview that they were in pain and were unable to sleep as a result. Worryingly, issues with a psychological underpinning were least likely to be raised, disclosed and explored; especially worrying in view of the longstanding nature of this condition. On many occasions issues were not raised by the nurse or disclosed by the patient.

 

[...] during unstructured interviews, participants openly spoke of the devastating impact of their wounds; speaking of pain, odour, exudate, social isolation and recurrence. Despite such open and frank disclosure, observed consultations with the same participants and their nurses revealed a lack of disclosure of those same themes [...]

 

In response to these findings, a nominal group, including patient representation, was undertaken and during the meeting a simple patient-led consultation template, the LUCT, was developed to direct the nurse and the patient to discuss and act on issues that were impacting on the person's quality of life.

A small-scale pilot of the template indicated a positive trend of improvement in both consultation satisfaction and some quality of life outcomes.

Since 2014, the leg ulcer consultation template  has been adopted by several regional trusts, in either paper or electronic form, but uptake has been slow. The template is aimed to promote problem solving in relation to the issues raised, rather than simply discussion. Feedback has been positive, indeed, when used in a wound care clinic alongside a vascular surgeon, care was changed in relation to patient responses in eight out of nine of the cases reviewed.patient form

The LUCT is a simple template that gives the person with leg ulceration a voice during their consultations, allowing them to direct their care to issues that really affect them.

This project has focused on methods to enhance the roll out of the leg ulcer consultation template to a wider audience and to raise its profile. The most recent CQUIN, Indicator 10, requires an improvement in the assessment of wounds to include the impact on quality of life; a requirement that would effectively be met by application of the LUCT and action on the findings.

Aims and objectives

To increase the impact and national roll out of the template. 

For effective project management, roll out strategy and mentorship support.

  

The leg ulcer consultation template is a simple template that gives the person with leg ulceration a voice during their consultations, allowing them to direct their care to issues that really affect them

  

nurse talking to elderly woman


Worryingly, issues with a psychological underpinning were least likely to be raised, disclosed and explored; especially worrying in view of the longstanding nature of this condition. On many occasions issues were not raised by the nurse or disclosed by the patient

Objectives

  • To have an article published to promote the leg ulcer consultation template
  • To record the webinar to promote interest in the template
  • To continue to network locally, regionally and nationally
  • To liaise with the West Midlands Academic Health Science Network (WM AHSN) to increase template adoption
  • To develop a simple version for patient/carer self-completion prior to clinician review
  • To explore a mechanism for scoring the template
  • To secure RCN endorsement for the template
nurse talking to patient

Outputs to date

  • Part two is currently under review by British Journal of Community Nursing. Part one will soon be published
  • The project has been published on the Meridian site of the West Midlands Academic Health Science Network (WM AHSN) 
  • The LUCT is being introduced as part of a leg ulcer pathway in Knowsley, supported by a wound care company called URGO. The LCUT is being used within South Manchester and Staffordshire and Stoke-on-Trent Partnership Trust
  • Webinar was recorded on 8th January 2018. It is a 40-minute webinar that focusses on the research underpinning template development. This will be available via the RCN District Nursing Forum website and Facebook pages
  • A simple communication version is under review by Reach, a learning disability review committee. This will be completed by the end of January 2018
  • To consider roll out as a generic wound assessment rather than being restricted to CVLUs

Lessons learned

  • Clear communication is essential for colleagues to understand purpose and utility
  • Challenges within the publication process resulting in delays to publication
  • Time scales, the need to constantly push the project and encourage engagement of colleagues
  • Having a plan and building outputs along the journey
  • Listening to support and advice and acting on it – appreciating the knowledge, experience and support of a mentor
  • To link to national targets, e. g. new CQUIN target 
open book

Reflections on impact

The leg ulcer consultation template aims to simply focus a clinician-led consultation on the needs of the patient, in relation to their day to day living. Experience, observation and research evidences that consultations for patients with a chronic venous leg ulcers  tend to have a wound focus and fail to explore the wider needs of the patient. Although the patient’s focus is most often also the healing of their wound there are many day to day impacts that could be alleviated, if the clinician were made aware.

 

The leg ulcer consultation template aims to simply focus a clinician-led consultation on the needs of the patient, in relation to their day to day living

 

My study evidenced a lack of disclosure by the patient; the application of this template would ensure all potential impacts are explored and would enable trusts to meet indicator 10 of the current CQUIN.

Research evidenced an impact on patient satisfaction and quality of life when the templated was used during consultations. Evidence of application during a vascular clinic evidenced that completion promoted changes to treatment. The current development of a simple communication version for self-completion for patients with any type of wound will be evaluated in the near future. I am hopeful that this will have a positive impact and open up communication channels between the patient and their nurse.

nurse talking to patient back

The way forward

I feel that roll out of the leg ulcer consultation template in its current form and exploration and roll out of a simple communication, generic wound version would be beneficial locally, regionally and nationally and would enable compliance with the current wound care CQUIN. 

With RCN support, endorsement of the template and a structured, national rollout programme, the focus of wound care consultations could be changed to really provide our patients with a voice.

Sustaining momentum

I will continue to pursue activities that are, as yet, not completed:

  • Publications
  • Completion and evaluation of a simple, generic checklist version
  • Raining the profile wherever possible, conferences, publications, webinars, etc.
  • To promote the recently recorded webinar
  • To pursue RCN endorsement
  • To link in with national initiatives, e.g. CQUIN