My role is unique. I am employed by a Primary Care Network (PCN), via Additional Roles Reimbursement Scheme (ARRS) funding, to provide specialist tissue viability support and advice to primary care nurses within the network, after two Practice Nurses identified a need to improve wound care and reduce the impact within their practices and for the patients. They petitioned the PCN Board for a dedicated TVN to be employed. There are only 2 of us doing a similar job (to best of my knowledge) in England. Many practices have withdrawn from providing complex wound care.ie leg ulcers or wounds that fail to heal. 

Leg ulceration management has a significant impact on GPN workload and cannot be managed in a 10-minute appointment. Therefore, a management plan in place immediately on presentation can save time, money and the detrimental impact on the patient. 

How? When a patient presents for the first time with a lower limb wound consider implementing the Immediate and necessary care for lower limb wounds as advocated by the National Wound Care Strategy.  Follow this up with a planned full lower limb assessment including ABPI. The PCN have supported this by purchasing an early intervention pack for each surgery, so up to 20mmHg compression can be applied immediately. With my support, all surgeries now can implement compression early.

Prevention of leg ulceration and the progression of oedematous lower limbs to lymphoedema is my passion. Once a patient is on this trajectory it increases the risk of cellulitis, hospitalisation and ulceration. I have a lower limb chronic oedema preventative service one day a week. I receive referrals for patients who have had lower limb oedema for more than 12 weeks, who do not have heart or kidney failure, or oedema/lymphoedema related to cancer or cancer treatments.

I provide a full holistic assessment and where appropriate get them into strong compression as soon as possible. Using a quality conversation approach I make sure they know it’s a lifelong condition and that some form of compression will be needed to manage it. This can be started in primary care by GPNs. So yes, you can stop leg ulcers in their tracks by treating them quickly and reducing the risks of ulceration by identifying and managing the early stages of chronic oedema and venous disease.

Although legs are my passion, I also support the staff in making evidence-based dressing decisions. One patient had been seen by both DN team, GPNs and self-cared for 20 months before a referral was made to me. That previous treatment cost of approx. £6900.00. I assessed, offered another option which enabled self-care, and the wound healed within 4 weeks, cost £100.00.

Not every PCN has a dedicated TVN but utilise your local TVNs to support you to manage wounds better and prevent them from happening.