A new model of care for ‘leaking legs’ (lymphorrhoea) in the community

Abstract

A Macmillan-funded lymphoedema/chronic oedema service was commissioned in an inner-London primary care trust (PCT) at the end of 2006 following a scoping exercise. A handful of patients were known to the PCT who had lymphoedema. It was expected that most lymphoedema patients would have lymphoedema secondary to cancer or its treatment. The PCT has a population of 202 000, 51% female and 49% male, 16% of those are 55 or over, compared to a national average of 20.45%, therefore having a younger population than average. Anecdotal information was gathered by the lymphoedema specialist about a large number of patients with wounds on their legs. Nurses often reported their dislike in seeing them, often going off sick with back pain related to treating these patients, and the managers need to allocate different nurses to these patients to spread the perceived heavy workload these patient generated. The average dressings consisted of alginate dressings and crepe bandages. To ascertain the extent of the ‘leaking legs’ population a prospective audit was carried out by the lymphoedema specialist. The results showed a large number of patient affected by leaking legs, cared for by community nurses with poor healing rates. A business case was successful in funding a nurse to treat this population and a new model of care was introduced, with excellent results, resulting in savings to both the nursing and the dressing budget, as well as improved patients outcome.