Tissue viability
This classification illustrates how adherence to treatment is multidimensional and can be impacted by various demographic, socio- economic, financial, and climatic factors. Like many other chronic conditions, wound care requires patients to play a vital role in their own recovery. Without the right environment and support, patients will struggle to adequately treat their wounds – as was largely the case during COVID-19.
Treatment insights: a case study A recent insights survey conducted by Sky Medical Technology explored the emotional impact of venous leg ulcers (VLUs), adherence to standard of care (compression therapy), and alterations in the level of care as a result of the pandemic. Eight vascular surgeons, six tissue viability nurses (TVNs), six community nurses (CNs), and nine VLU patients across the UK were asked about the treatment prescribed and the effects of COVID-19 on healthcare delivery. The survey, conducted remotely via
teleconference calls, examined the narratives expressed to understand any changes in the care provided, including: The extent VLU patients felt involved in
treatment decisions, the location of care during and since COVID-19, the extent patients self-manage and the extent any change to care brought on by COVID-19 might be lasting. The survey also examined the narratives
expressed by vascular surgeon to determine any barriers and facilitators to their championing MedTech innovation within their primary network.
Common themes and findings 1. Delivery during COVID-19 A stand-out finding, expressed by all CNs, in context to the pandemic, was the re- deployment of wound specialists, such as TVNs, to the hospital setting to support the delivery of COVID-19 critical care. While completely understandable, this refocus of a critical resource was to the detriment of wound patients suffering with acute and chronic conditions.
Most wound clinics were also suspended. All
CNs reported the rapid creation of materials to support patient self-care, in the home setting – with most utilising materials created by the National Wound Care Strategy Programme (NWCSP) in written and video format to help instruct patients on how to wash legs, care for wounds and apply compression correctly. When asked if they felt this would advance the patient self-care agenda post-pandemic, they were unsure but collectively agreed that embracing VLU self-care is needed – not least as many wound care professionals are leaving the service.
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When asked if they were able to complete full
lower-limb assessments during the pandemic, including Doppler (to rule out arterial disease), all CNs reported delays but recognise early assessments as essential.
2. Telemedicine With fewer face-to-face visits, all CNs also reported some use of telephone triage but felt it to be less effective, particularly for patients who struggle with phone/internet access and internet literacy. All CNs were open minded to the role of tele-triage but expressed a common concern that self-care and/or shared-care first requires a full, holistic assessment and the development of a care plan that both a patient and carer can adhere to and feel confident of. Particularly as applying the correct level of compression (be that two-layer, wraps or hosiery) requires a compression level many patients can find hard to tolerate – causing low adherence and concordance to standard of care. CNs also reported that approximately one
in four of their VLU patients are unable to remember or understand information provided to them, due to cognitive and memory problems.
3. Healthcare resources All TVNs interviewed expressed the concern that generalists within the community nurse teams – prior, during, and since COVID-19 – are
There have been few improvements over the last 30 years in the levels of adherence to wound care.
continuously asked to work more with fewer resources. Vacant posts are currently left unfilled as the UK is embarking in a recruitment crisis and, however good-willed the generalists are, there comes a time where they struggle to find the time to dress wounds as part of ‘basic nursing care’. Wound care is increasingly delegated to healthcare assistants within primary care and the role of the TVN is in educating and training unregistered colleagues, but also in supporting generalists in recognising their accountability. They also expressed the need to address comorbidities, such as obesity management and exercise with patient healthcare coaching.
4. Embracing innovation In speaking with the vascular surgeons, they expressed not having a positive perception of the standard of wound care in the community, in respect to timely expertise to diagnose and refer leg ulcer patients to vascular teams. On the question of championing MedTech innovation to improve VLU healing, the majority expressed that they would be motivated to embrace innovation but would require to see robust clinical evidence. Most also indicated the lack of a robust framework between secondary and primary care to achieve full adoption within local networks.
5. Emotional impact Unsurprisingly, all patients reported experiencing: pain, discomfort, social isolation, malodour, exudate leakage, reduced mobility – expressing that VLUs stop them living their lives and robs them of hope. Those with long-term unhealed VLUs also expressed feeling: anger, denial, guilt, aggression, depression, grief, anxiety and feelings of worthlessness.
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