“I am delighted to support this valuable initiative which has proven to reduce the recurrence of leg ulcers and further reduce the need for hospital based services,” according to Mr Madhavan, Vascular Surgeon based in the Midland Regional Hospital Tullamore and St James’s Hospital, Dublin, speaking about a new Vascular Outreach Integrated Care Clinic.

Dr Madhavan provides clinical governance to the clinic which is run jointly by Maree Healy, Registered Advanced Nurse Practitioner (RANP) in Tissue Viability Midland Regional Hospital Tullamore (MRHT) and Dr Mary Costello RANP Tissue Viability Laois Offaly Public Health Nurse (PHN).

The clinic takes place in Tullamore Primary Care Centre twice monthly. Dr Costello explains that “our focus is the impact of patient education on the prevention of recurrence of lower limb ulceration. During the sessions we cover topics like skin care, leg exercises, compression therapies, hosiery, modes and devices to apply and remove same. And we also afford patients and their family time to ask questions.”

Adding that patients have embraced the service for its practicality and convenience, Dr Costello notes how patients no longer need to attend a busy hospital setting but can attend a community clinic which can be more accessible for many.

An educational focus has led to the development of a club entitled ‘Legs 11’ - an evidence-based patient educational programme on lower limb self-care and prevention of recurrence of venous ulceration. It addresses the learning needs of patients who are embarking on the journey of self-care post-healing of a lower limb ulcer. The programme takes place in Tullamore Primary Care Centre twice monthly and has recently been extended into other community areas including Portarlington and Mountmellick.

Maree Healy explains that “using educational material from the HSE and the Legs Matter organisation, the focus for ‘Legs 11’ is on rehabilitation for patients post-ulceration. We look at self-care, as well as shared care which educates family members and carers and provides education on the prevention of recurrence. A KPI (Key Performance Indicator which demonstrates the target) was set at less than 40% recurrence at the outset of the programme. Now one year on from the launch we have identified a 0% recurrence which is a fantastic achievement.

“Feedback from the patients attending the sessions was very positive. They told us they were seeing the link between daily leg care and the prevention of ulcers. Another told us they now understood what good circulation means, and another said they now understood why good skin care was so important.”

Brendan Malone, Director of Nursing MRHT added that “as care providers we aim to deliver safe, quality and person-centred integrated care for our patients. Here at MRHT, we are delighted to see the addition of this educational element to the vascular outreach clinics. Not only are the clinics more convenient for patients but they allow for trusted relationships to develop which can mean that patients may be more likely to ask questions they have about their care. Patients and their families will benefit hugely from this person-centred care.”

Kate Egan, Director Public Health Nursing, Midlands Louth Meath, further added that they “warmly welcome this collaborative clinical integrated initiative between Primary Care and MRHT. It represents a valuable step towards hospital avoidance and offers enhanced educational opportunities for clients in the community.”