Neighbourhood

Team: Neston and Willaston Community Care Team
Contact: stephaniefletcher@nhs.net 

What did we want to achieve?

Following review of quantitative data on wound healing times across the Neighbourhood care group, the Community Care Team in Neston and Willaston felt they needed better oversight of wounds on their caseload, to see if this would decrease healing times of non-healing wounds.

They sought to:

• improve wound data quality to reduce clinical hours spent on reviewing caseloads manually
• monitor non-healing wounds closely so problems could be escalated appropriately and efficiently with the view to progress wound healing rates and improve patient outcomes
• add data on non-healing wounds to community care team spot checks
• develop a non-healing wound pathway

What we did

The team collaborated with CWP data analysts to compile reports on non-healing wounds, which were interrogated by Community Care Team staff to see if there were any recurrent themes that could inform improvements for wound care practice. Clinical lead colleagues across Neighbourhoods were also invited to complete a survey on non-healing wounds and current practice, which showed a need for a non-healing wound pathway. A pathway with guidance was created and circulated to colleagues, assisting colleagues to investigate non-healing wounds in greater detail and providing prompts for treatment plans and escalation to other services.

Results

Interrogation of wound data showed that data inputting errors are common and that this makes non-healing wounds difficult to report.

This has paved the way for the Community Care Team to be part of a pilot scheme testing AI-assisted wound assessments. The team was able to show that small changes to wound assessment templates used on EMIS would improve data input. Templates were altered based on these findings. Non-healing wounds are now part of monthly spot check audits which means wound data is easily available for colleagues to investigate. The team hopes emerging data will show wound healing rates are improving.

Next steps

The pilot scheme for AI-assisted wound assessments should provide rich data that the Community Care Team hopes to use for research into lower leg wound healing rates. This research will inform treatment plans with a view to reducing leg ulcer healing times by two to three weeks. The team is aiming to utilise the non-healing wound pathway in the pilot scheme to ensure all wounds on the caseload are monitored closely. They will continue to evaluate wound healing rates and will be seeking staff and patient views throughout the year-long pilot scheme.

Team: All Care Community Teams and Dressing Clinics
Contact: helencunningham@nhs.net

What did we want to achieve?

The aims and objectives of the project was to enable clinicians to make direct referrals to the Vascular Service without having to go via the GP practice. The project has enabled clinicians to complete the whole episode of care as autonomous practitioners following their episode of care and treatment. 

Since the introduction of revised national guidance with regards to aspects of care for lower leg wounds, the GP practices raised concerns of the increased volume of referrals required to be sent to the Vascular Service. This has empowered clinicians to complete the whole episode of care and reduced GP requests. 

What we did

In conjunction with the Electronic Patient Record (ePR) Transformation and Innovation Lead and ICT Registration Authority Manager, the teams scoped if there was a way of making direct referrals to the Vascular service. This was discussed and approved as a way forward with vascular team colleagues and partners who were supportive. The teams trialled the initiative for several months within the Central Dressing Clinic and ironed out any issues. They developed a standard operating procedure.

Those involved have included Dawn Davies, Mo Phillips, the Dressing Clinic Team, the Central Dressing Clinic Administration Team, Declan Beddis, Melanie Weston and Countess of Chester Hospital vascular colleagues.

Results

Following a successful pilot, the teams are now training all other teams, supported by a training video that they have created and the standard operating procedure.

The aim is that this will be put into practice within every team early April 2025.

Next steps

The plan is to roll this out to include Wirral and Warrington Vascular services. The team’s plan is to include the Podiatry Service referring to vascular using this method too. They will also look at what other services within the portfolio could use direct referrals via the electronic referral system.

Team: Continence and Urology Service
Contact: c.evans13@nhs.net

What we wanted to achieve

Claire Evans, a community urology lead nurse specialist also works as a urology scrub nurse in secondary care. Three years ago, whilst in theatre, she was supporting a surgical procedure on a young patient who had irreversible damage to their urinary system secondary to recreational ketamine use. Soon after, she noticed an increase in young people with irreversible damage to their urinary system in primary and secondary care. It became apparent to Claire that there was an increase in recreational ketamine use and education was vital. Therefore, she dedicated her spare time to carry out preventative work. 

What we did

Claire began visiting schools, youth services, charities and a local prison service to provide the preventative education. She presented to pupils, staff and volunteers that worked alongside youths. She was also invited to present her work at CWP’s Physical Health Conference. Due to the target audience at the conference, she was approached by Public Health and invited to join a Ketamine Harm Reduction Task and Finish Group. Since joining this group, she has been commissioned by the local authority to provide educational sessions on a weekly basis. She has also started providing the educational sessions to GPs.

Results

Positive outcomes have unfolded across both settings:

• Young People’s Community Drug and Alcohol Misuse Service has seen an increase in ketamine referrals.
• Young people are managed with correct medication whilst they are waiting for review in secondary care.

Feedback has included:

“Claire advised me to use certain medications, which I now take on repeat prescription until my body heals. Claire regularly checks up on me, giving me advice and answering any questions. Without the advice and support Claire has given me, I wouldn’t be where I am now. I will always be so grateful and will never be able to thank her enough.”

Next steps

Claire’s plan is to develop a model of proactive care (ketamine champion model) and health prevention education whilst raising awareness amongst young people. This will enable clinicians to identify ‘red flags’ surrounding recreational ketamine use, whilst recognising early signs and symptoms of ketamine-induced uropathy in young people. Clinicians would then be able to provide preventative education and signpost to relevant support services.

The ultimate aim is to reduce health inequalities within young people whilst preventing irreversible damage to their urinary system secondary to recreational ketamine use.