Top-Scoring Nurse Research Abstracts Symposium on Advanced Wound Care (SAWC) Spring 2019
Alice Bourke, MN; Natalie Scott, MN
Our district nursing service faces a burgeoning aging population with increasing numbers of complex venous leg ulcer (VLU) referrals. Our response to this growing wound problem has been to implement a new specialized, early assessment and intervention model. Previous service audits identified recurrent VLUs take longer to heal than first presentations. Previous VLU healing times averaged 33 weeks.
A clinical audit research project was undertaken (2017-2018) that aimed to determine healing rates and establish whether early intervention and compression bandaging in the first 6 weeks of ulceration could reduce chronicity. A secondary aim was to identify healing rates for new VLUs over recurring VLUs.
The clinical, etiology, anatomy, pathophysiology (CEAP) venous classification tool was used to enable early identification of potential slow healing. Doppler ankle-brachial pressure indices (ABPIs) were measured and compression bandaging commenced accordingly. Healing expectations were set at 25%cm2 wound area reduction within the first 4 weeks. This was monitored using accurate reliable camera imaging devices with confidential patient records system capability
A retrospective observational study was implemented. Lower limb ulcerations were identified by statistical coding (excluding arterial and cancerous wounds). Time to heal and time until the patient received a Doppler assessment were analyzed using descriptive statistics and their relationship using nonparametric Spearman’s rho test. Continuous variables analysis was measured by means of variance (ANOVA) and independent Students t test. A statistical software package provided statistical analysis.
Out of 247 VLUs, 219 (88%) healed within 28 weeks with an average healing time of 9.70 ± 7.12 weeks, 82% healed by 24 weeks, 49% received compression in first 6 weeks,
68.4% received compression during their 24+ weeks VLU duration. “Other” ethnicities showed significant statistical difference in age of VLU onset.
Investing in increased access to specialized wound nurses enabled improved VLU healing outcomes and reduced chronicity.