Tissue viability
compression system (ReadyWrap). Capacity and capability assessments were
conducted with patients and carers to evaluate their ability to follow care instructions, apply compression, and monitor wounds. To support this process, the patient or named carer was required to provide appropriate responses to the suitability criteria (Fig. 5). Once suitability was confirmed, patients
were given comprehensive support materials supported by L&R Medical UK. These included a ‘Lower Limb Passport,’ a ‘Caring for Your Venous Leg Ulcer at Home’ leaflet, and essential contact numbers. Eligible patients also received a personalised ‘My Leg Diary’ to promote ongoing engagement and self-management (Fig. 6). The diary was designed to cover day-to-day aspects of lower limb care, enabling patients to track wound progress, while reinforcing key education points. Sections included: l Treatment plan overview: Space to record current skincare, dressings, and compression system, ensuring patients and carers had a clear reference point.
l Dressing change schedule: Prompts to note specific days for dressing changes, promoting adherence to care plans.
Is the patient or carer clinically and functionally able to self-care in compression? Are they able to manage their condition, e.g. leg ulcer hosiery kit/Readywrap (based on Best Practice Leg Ulcer Pathway)?
YES
l Daily monitoring: Tables to capture the time of dressing changes, pain scores (0–10 scale), and overall wellbeing, enabling patients to reflect on their progress and provide clinicians with meaningful updates.
l Notes and questions: Free text areas where patients could record any concerns, challenges, or questions for their clinician, encouraging open communication and timely intervention.
l Leg highs and lows: Space to highlight positive experiences (e.g., improved mobility, social activities) alongside difficulties (e.g., challenges with hosiery application), supporting a holistic approach to wellbeing.
Patients and carers were shown how to complete entries, with examples demonstrating the value of tracking symptoms such as pain, swelling, or changes in exudate (Fig.6). Clinicians reviewed the diaries at follow-up visits, allowing them to assess adherence, identify potential complications and tailor advice to individual needs. By integrating the My Leg Diary alongside the Lower Limb Passport, patient information leaflets, and focused
education, the approach encouraged active participation in care, improved self-efficacy, and supported safe self-management within the agreed capacity and capability framework. Once enrolled, patients and carers
participated in a structured education programme covering skin hygiene, exercises to support venous return, recognition of early warning signs such as swelling or changes in exudate, and the correct application of compression garments. To reinforce this learning, L&R Medical UK supported the development of patient friendly resources, including illustrated leaflets, online instructional videos, and simple home use checklists. For patients requiring additional support, compression application aids were also provided to address dexterity challenges (ActiGlide). Support was not withdrawn entirely; instead,
an evidenced-based hybrid system was implemented.6
Patients were reviewed face NO
Follow the Best Practice Leg Ulcer Pathway with clinician led care
to face every six weeks, with interim virtual contact via telephone or video at least every two weeks. A rapid escalation pathway was established to ensure that clinical intervention could be reinstated immediately if any changes in condition or deterioration occurred. This combination of education, empowerment and safety netting created a framework that was safe, flexible and robust, enabling patients to play a more active role in their care, while ensuring continuous access to professional support and guidance.
Does the patient or named assistant have the ability to understand the following?
Comprehension of the wound Can they describe their diagnosis? (E.g. ulcer/a skin tear on lower limb)
Signs of infection and risk of wound deterioration Do they know the signs of infection and who to contact?
Able to understand their specific treatment plan Are they able to follow instructions and carry out the treatment?
Has a facility or a safe environment? Able to perform wound care at home?
Do they have all of the above to be able to carry out self care for up to 6 weeks?
Issue patient/named carer with patient specific self care plan booklet and confirm how to contact clinician if needed
Delivering change The process of delivering change across the teams was deliberately phased. We began with a pilot programme in two localities/teams, involving a small cohort of patients identified by the community nursing teams. This pilot allowed the tissue viability team to test the feasibility of the pathway, evaluate patient responses, and gather baseline data on outcomes. Education resources were co-designed with patients, an approach that proved invaluable. Patients advised on the clarity of language, the usefulness of illustrations, and the preferred formats for information delivery. This ensured that information could be revisited as often as necessary and was not lost after a single consultation. Staff engagement was achieved through targeted training sessions that emphasised a shared responsibility model. Nurses were reassured that the goal was not
Fig.5 Capacity and capability assessment
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to diminish their role, but to elevate it, freeing them to apply their specialist expertise where it made the greatest impact across their entire patient caseload. Support structures were carefully planned, with dedicated tissue viability support and rapid escalation pathways ensuring
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