Best practice for chronic oedema in community settings: what can we learn?
There are various opportunities and challenges in the delivery of care to those diagnosed with chronic oedema/lymphoedema. Service provision is not consistent within the UK, and non-specialist nurses and other health professionals may be called on to fill the gaps in this area. The latest best practice guidance on chronic oedema is directed at community services that care for people within their own homes in primary care. This guide was developed in order to increase awareness, knowledge and access to an evidence base. Those involved in its creation cross specialist fields (lymphoedema and tissue viability), resulting in the document covering a number of areas, including an explanation of chronic oedema, its assessment and management and the association between chronic oedema and wet legs. The document complements existing frameworks on the condition and its management and also increases the available tools within chronic oedema management in the community. The present article provides an overview of the guidance document and discusses its salient features.
The creation of the latest guidance ‘Chronic oedema: best practice in the community’, builds on work that has been done in the past and presented in the original guidelines ‘Best practice for the management of lymphoedema’ and the ‘Compression therapy: a position document on compression bandaging’ (International Lymphoedema Framework (ILF), 2006; 2012). Equally, it complements other guidelines that have been created, for example, ‘S.T.R.I.D.E. professional guide to compression garment selection for the lower extremity’ by Bjork et al (2019) and others shown within Table 1. The best practice and/or statements bring together the best available evidence at that time, alongside clinical opinion. These form part of the principles that are present in the application of evidence-based practice and how this can improve the care of patients (Black, 2015; Brownie, 2018). It has been estimated that some 4 per 1000 individuals in England may be affected by chronic oedema, and this figure increases with age to up to 29 per 1000 individuals (Moffatt et al, 2017). Individuals with chronic oedema who are older, for example those older than 65 years, may also present with multiple long-term conditions, and be already receiving care from several services, both primary and secondary (Rankin, 2016; National Lymphoedema Partnership (NLP), 2019). This adds complexity to the care that those diagnosed with chronic oedema or lymphoedema may receive from health professionals. It also adds emphasis to the need to have access to guidance and best practice in managing these patients.
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