Compression therapy for NHS inpatients with leg ulcers: a literature review.

OBJECTIVE: Leg ulcers are common, distressing and painful for patients, and are a significant financial burden to healthcare providers. Compression therapy is the mainstay of treatment for venous leg ulceration. Several studies have evaluated leg ulcer management and compression therapy in the community. However, little is known about the prevalence of leg ulceration and use of compression therapy in acute hospitals. The aim of this study was to explore the published literature on the use of compression therapy for inpatients with leg ulcers in UK National Health Service hospital settings. METHOD: A literature search was undertaken to identify published papers reporting on inpatient leg ulcer populations and the use of compression therapy in hospitals using the following databases: CINAHL, MEDLINE Complete, Embase and PubMed. RESULTS: The literature review identified 364 articles, of which three met the eligibility criteria. These studies reported on the prevalence of leg ulceration, the number of Doppler assessments conducted for patients and the use of compression therapy. CONCLUSION: This review confirmed a lack of information on the prevalence of hospital inpatients with leg ulcers, and identified the need to conduct prevalence audits, establish leg ulcer services to streamline inpatient leg ulcer care and provide staff and patient education programmes.

A point prevalence audit of inpatients with leg ulcers eligible for compression therapy in a large university NHS hospital.

OBJECTIVE: Compression therapy is the mainstay of treatment for venous leg ulceration. Several studies have evaluated leg ulcer management and compression in the community. However, little is known about the leg ulcer population and use of compression therapy in the hospital setting, where it is not often part of inpatient care. This study aimed to evaluate the proportion of inpatients with leg ulceration eligible for compression therapy. METHOD: A point prevalence audit was undertaken using three methods: patient electronic live report; a leg ulcer audit form; and an electronic record search. The following data were retrieved: patient age, sex, primary reason for admission, diabetes, mobility status, history of dementia, Clinical Frailty Scale score and presence of oedema. Ankle-brachial pressure index was measured to determine patients' eligibility for compression therapy. RESULTS: The audit identified 80/931 (8.5%) inpatients as having confirmed, active leg ulceration. A total of 36/80 (45%) inpatients were assessed for eligibility for compression, of whom 25/36 (69.4%) were eligible for full compression, 2/36 (5.6%) reduced compression and 9/36 (25%) were not eligible for compression therapy. CONCLUSION: The audit demonstrated that a significant proportion of hospital inpatients with leg ulcers were eligible for compression therapy and that this patient population were heterogenous in terms of comorbidity profile, mobility, frailty and dementia, among other factors. Further research is required to explore the most feasible and effective compression options for inpatients with leg ulcers.

Leg ulcer service provision in NHS hospitals.

AIM: To explore the service provision for compression therapy for inpatients with leg ulcers in UK hospitals. METHODS: An online survey was carried out to explore the service provision in hospital settings. It was distributed to Wounds UK National Conference delegates and to wound care specialist groups using social media. RESULTS: The authors received 101 responses from health professionals in the UK. Of these, 67.3% reported there was no dedicated service for inpatients with leg ulceration and only 32% said compression therapy was provided in their hospitals. CONCLUSION: This survey confirmed there is a significant shortfall in care provision for patients with leg ulcers in secondary care and highlighted the wide variations in service delivery in hospitals. Further research is needed to understand the reasons for these variations.

Treating patients with venous leg ulcers in the acute setting: part 1.

Leg ulcers present with a variety of aetiologies, sometimes in combination. The most common aetiology is venous, with treament involving compression, elevation and exercise; the most common treatment setting is the community. However, people with leg ulcers do sometimes require admission to hospital for conditions and situations which may, or may not, be ulcer-related. There is a lack of contemporary evidence on the experience of inpatients and insufficient analysis of the impact on healing and complications to the lower limb when patients with leg ulcers and compression therapy are admitted to hospital. Admission to hospital presents an ideal opportunity for a focus on leg care and potentially enhancing healing rates of patients. The reality for patients with venous leg ulceration being treated with compression therapy is that this does not continue if they are admitted to hospital as inpatients-having been interrupted for MRSA screening and skin assessment, often no-one is available to reinstate the therapy. This article highlights key issues in the ongoing care of these patients and offers suggestions for basic management until a more acceptable and evidence-based solution can be found. Part 2 will deal with the preparation for discharge and options for the treatment of patients who are not already in the care of community services.

Optimising concordance with compression hosiery in the community setting.

Compression hosiery is used to help prevent leg ulcer recurrence by controlling venous backflow and the build-up of lower-limb oedema. The therapy is effective, but only if it is worn consistently by patients. In order to promote concordance with ongoing management, it is important that practitioners are aware of the options available in terms of design, structure, colour and size of compression. It is also vital for practitioners to consider a range of strategies to help patients apply and remove the hosiery.

Education saves lives.

I was asked recently to run a one-day leg ulcer course. The expectation was that participants could do patient assessment and Doppler in the morning, bandaging in the afternoon and a competency test at the end (and could we finish by 3.30, please).

Compression hosiery to reduce leg ulcer recurrence.

This article provides an overview of the extent of venous leg ulcer recurrence and the role of compression hosiery in venous leg ulcer prevention. It also identifies the problems patients have using compression hosiery and explores practical solutions.

FAQs on leg ulcer care.

In a webchat on leg ulcer management issues, hosted by Nursing Times, participants raised three key areas of care: the role of healthcare assistants in compression bandaging; reporting and investigating damage caused by compression therapy; and recommendations for dressings to be used under compression. This article discusses each of these in turn.

Multidimensional leg ulcer assessment.

Assessing patients presenting with a leg ulcer is like doing a multidimensional jigsaw puzzle, in which all the pieces need to fit together to make a whole picture that has depth and meaning. This enables rational clinical decisions to be made with patients, according to their capability and agreement to be involved. This article highlights some of the key features of leg ulcer assessment, drawing on recommendations in national guidelines.

Key principles involved in applying and removing wound dressings.

This article aims to help practitioners consider a variety of wound dressings and develop their knowledge about the use of dressings to ensure patients are protected and care is cost-effective. The article focuses on which dressing should be used depending on wound type and how different dressings should be applied and removed. Author

Avoiding plagiarism in academic writing.

Plagiarism means taking the work of another and presenting it as one's own, resulting in potential upset for the original author and disrepute for the professions involved. This article aims to explore the issue of plagiarism and some mechanisms for detection and avoidance.

Mixed aetiology: complexity and comorbidity in leg ulceration.

Leg ulceration is a condition involving many factors that make assessment and management complex. When comorbidities add to this complexity it is particularly important that clinical management is by highly skilled practitioners in order to facilitate the best possible chance of ulcer healing and to reduce the risk of further complication. This article highlights key comorbidities and the range of reduced compression therapies currently used in clinical practice.

Compression bandaging in patients with venous insufficiency.

This article explains the effects of compression therapy and discusses the treatment options available in the management of patients with venous disease of the lower limb.