About the programme

A study by the NHS Benchmarking Network in 2021 estimated that wound care cost the sector £8.3bn each year and can take up 50% of community nurse time.

A large proportion of this is spent on caring and managing lower limb wounds, ulcers and surgical wounds. By improving wound care, it’s possible to speed up healing and reduce the recurrence of wounds for patients, making their recovery shorter and more comfortable, while saving resources and time. 

Working in collaboration with Birmingham and Solihull Integrated Care System (ICS), Health Innovation West Midlands (HIWM) launched a wound care pilot project to help improve the way wound care is approached.

What is the aim of Wound Care Pathways?

The programme sought to develop an educational programme of support to primary care networks (PCNs) in delivering evidence based wound care, by implementing a pathway based on best practice.

The aim of the pathway is to encourage faster healing of wounds, give patients improved quality of life, reduce the likelihood of wound recurrence and ensure a more efficient use of resources.

Additionally, the programme included the development of a resource package and establishing a dedicated wound care clinic to further support PCNs in delivering the best possible wound care to patients.

Our Approach

Through collaboration with PCNs within the Birmingham and Solihull ICB, HIWM developed a learning matrix with tiered options to align with staff’s existing levels of knowledge.

All appropriate staff within the ICB completed a 1.5 hour e-learning course covering the fundamentals, with certain individuals continuing on to complete three

hours of face-to-face learning. The in-person training covered topics such as wound types, treatments, formulary choice, red flags, compression and introduction to local pathways.

HIWM also facilitated the development of a resource package to support the assessment, diagnosis and onward referral, which encompassed methods for both simple and hard to heal lower limb pathways.

To address more complex cases beyond the scope of the training a dedicated wound clinic was created, managed by clinicians possessing extensive knowledge in comprehensive assessments and treatment plans.

The implementation of clear pathways and specific inclusion criteria ensured a smooth flow of patients through the process.

Outcome

The resource package was developed and made available to the ICSs where nurses could take part in the resources and make referrals to the wound care clinic. During this time a real-life case study highlighted the benefit of its adoption and its contribution to the healing process.

The patient, a male aged 45-60, presented to the clinic with a traumatic wound on his left leg above the ankle, after his GP had tried to independently manage his care for several weeks.

After being assessed twice weekly for a number of weeks by the practice nurse, using a variety of dressings and oral antibiotics, there was no improvement to the wound bed.

The practice nurse received e-learning and a face-to-face education session on the lower limb pathway. Recognising the necessity for additional evaluation, the nurse referred the patient to the dedicated wound care clinic, part of this pilot programme.

At the clinic, a full vascular and wound assessment confirmed a venous aetiology. The patient was started on full compression therapy using a leg-ulcer hosiery kit, local formulary dressing products and education on self-management.

In the following weeks the wound showed signs of improvement with a reduction in size and pain. After nine weeks from the initial assessment at the wound clinic, it was considered healed – an improvement by a third, compared to the average healing time of three months. The patient was discharged back to the GP for ongoing hosiery management to reduce the likelihood of recurrence.

Patient feedback on the service was positive, with the patient describing it as, “absolutely excellent”, praising the advice provided and finding a sense of relief at having a management plan in place.

Find out more

For more information please contact a member of the team below.

• Joanne Terry, Innovation Project Manager: Joanne.Terry@healthinnovationwm.org