Tissue viability


analysed caseload volumes, leg ulcer prevalence, clinical resources, diagnostic equipment availability and staff competencies. This baseline assessment revealed a steady increase in patient numbers, substantial variation in clinical confidence, training needs, equipment availability and pathway readiness across the teams. The audit also highlighted gaps in Doppler


ultrasound knowledge, compression measurement, selection and application and understanding of the core principles of self-care. Currently, patients presenting with a wound are referred to the most appropriate care provider according to defined criteria. Individuals who are less mobile or housebound are directed to community nursing services, whereas mobile patients may be managed by practice nurses. Within the community nursing team, all wounds are assessed at the first visit and placed on a wound care plan. Wounds located between the ankle and knee then undergo a full holistic assessment, including vascular status, while wounds below the ankle are referred to podiatry services. Following this assessment and a differential diagnosis, patients are then transitioned onto a leg ulcer care plan, enabling treatment and management specific to lower limb wounds. Approximately 20% of patients may experience a delay or overlap when transitioning from a general wound care plan to a leg ulcer care plan. This was accounted for in the 12-month data analysis, which shows an increase in lower limb ulceration during this period (Fig.1). The Burden of Wounds paper reported an


increase in lower limb ulceration from 731,000 cases in 2012/13 to 1,054,000 cases in 2017/18 (+44.26%).2


incidence of lower limb ulceration has grown at a far greater rate, rising by 90.11% in just 12 months (Fig.2). To create a targeted and relevant clinical


training plan, a staggered survey was distributed to two teams at a time, and the results were used to shape the training content. The survey identified potential clinical challenges (Fig. 3) and patient-related barriers (Fig. 4) to implementing a self/shared care approach. These findings guided the prioritisation of key clinical focus areas and informed the design of a more effective and efficient onboarding process.


Using these insights, a phased education and


training programme was developed. Each district nursing base received equipment upgrades and targeted staff development to ensure competence before the programme launch. Training comprised pre-launch sessions, launch workshops, post-launch clinical workshops, and ongoing review meetings. Staff were prepared not only to support patients in self-care, but also


However, within the SWBH Trust, the


Month March


April May June July


August


November December January February


Wound Care Plan 117


102 98 99


122 112


September 120 October


111


144 148 138 168


Leg Ulcer Care Plan 112


125 117


142 184 165 200 184 224 209 231 241


Fig.1 Case load increase across SWBH over 12 months


350 300 250 200 150 100 50 0


Number of lower limb wounds


Low = Lowest patient number across the year (172)


LOW HIGH % INCREASE 172


327


Mar Apr May Jun 1


2 3 4


Jul 5


Fig.2 Number of lower limb wounds


l Enhancing staff understanding of the pathway and self-care processes l Overcoming entrenched practices and encouraging staff adoption of new models l Clarifying the practical requirements of the self-care model l Establishing reliable systems for the supply of dressings and equipment to patients l Determining the appropriate frequency and format of support visits l Assessing applicability of self-care models for complex cases l Providing sufficient training, resources, and ongoing support to staff implementing the model


Fig.3. Clinical and system related challenges


l Ensuring patient adherence to agreed care plans l Supporting patients unfamiliar with self-care practices l Addressing attitudes and beliefs to encourage engagement with self-care l Overcoming reluctance or resistance to self-management l Transitioning established patients from nurse-led care to self-care l Managing expectations of both patients and carers regarding roles and responsibilities l Responding to patient preference for professional led care rather than self-care l Facilitating behavioural change to promote self-management


Fig.4. Patient related challenges


to address the behavioural, cultural, and technical challenges of this transition, such as entrenched practice habits and the need to step back in a safe, structured manner. Patient selection criteria were established


to ensure both safety and suitability. Eligible patients required a confirmed diagnosis of a VLU, a recorded Ankle Brachial Pressure Index (ABPI), and the ability to use either a hosiery kit (Activa or Actilymph) or an adjustable


January 2026 I www.clinicalservicesjournal.com 55 90.11


Aug Sep Oct Nov Dec Jan 6


7 8 9 10 11


Feb 12


% increase = Patient increase across the year (+90.11%)


High = Highest patient number in the year (327)


Total Patients 229


227 215 241


306 277 320 295 368 357 369 409


Estimation (-20%) 183


182 172 193 245 222 256 236 294 286 295 327


t


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