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P159 Changing a Lymphoedema Service through Service Redesign
  1. Debbie Murphy
  1. St Catherine’s Hospice, Preston, UK

Abstract

Background Well established Lymphoedema service facing number of escalating issues:

  • Increasing referrals

  • Over budget

  • Frustrated staff

  • Lack of care pathways and long term management

  • Lack of innovation

Aim

  • Reduce financial strain

  • Provide clear care management strategy

  • Introduce self-management strategies

  • Ensure full access for individuals with Lymphoedema.

Approach Used

  • Poor team work - looked at strengths and the weaknesses of each team member as a team

  • Cost reduction – compression garment formulary assessed on cost effectiveness, size of range, availability on FP10, education supplied by the company.

  • Care pathways – patient journey plotted dependent on severity of condition.

  • Discharge policy developed, packs sent to the GP and to patient.

  • Long term self-management - six week education programme combined with fun exercise class (Le Bed), gives patients tools to manage own condition.

  • Following discharge from Le Bed, Lymphoedema Information Fun Event (LIFE) established after feedback from patients - provides ongoing information about service development. Group used as patient reference and involvement group e.g. feedback on leaflets etc.

  • Investment in new technologies (lymph assist machines, lasers, oscillator) - enhances treatments offered, produces quicker results.

  • Kinesio tape introduced

  • Children’s Lymphoedema Service initiated

  • Bra fitting service developed.

Outcomes

  • Greater sense of team - clear lines of reporting, goal setting and monitoring.

  • Expansion of team with a clear mix of skills

    • support worker undertaking more routine work, specialist nurses concentrate on more complex cases

    • part time specialist appointed

    • Lymphoedema physiotherapist (still to be appointed)

    • training and development - manual lymphatic drainage, Le Bed instructor training, bra fitting, wound management, child protection training etc.

  • Number of new patient referrals has increased year on year (see table)

  • Negotiated and secured contracts with three additional CCG’s

  • 2008/2009 = £23k overspend, 2011/2012 break even (including reinvestment in new technologies and education)

  • Number of intensive treatments increased from 27 in 2010/2011 to 119 in 2012/2013

  • Patients self-managing - the discharge pathway and Le Bed class – leading to greater self esteem

  • Lymphoedema manager recognised as Lymphodema nurse of the Year 2013, British Journal of Nursing

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