Early Specialized Nursing Assessment Decreases Healing Time and Reduces Chronicity of Lower Leg Wounds

Background: 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.

Purpose: A clinical audit research project was undertaken (2017-2018) 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.

Methods: CEAP venous classification tool was used to enable early identification of potential slow healing. Doppler ABPIs were measured and accordingly, compression bandaging commenced. 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 till patient received a doppler assessment was analyzed using descriptive statistics and their relationship using non-parametric Spearman's rho test. Continuous variables analysis was measured by means of variance (ANOVA) and independent students t test. 

SPSS statistical software package version 25 provided statistical analysis

Results:
219/247 (88%) VLU healed within 28 weeks.
Average healing time "9.70 weeks" (SD 7.12)
82% healed by 24 weeks
VLU recurrent rates  similar healing time to new VLUs
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

Conclusion: Investing in increased access to specialized wound nurses enabled improved VLU healing outcomes and reduced chronicity.