On the Ground Clinical Lymphoedema Education Programme for Community Staff (OGEP)
Melanie Thomas, Clinical Director Lymphoedema Wales, Swansea Bay University Health Board
Introduction
The 'On the Ground Clinical Lymphoedema Education Programme' (OGEP) aimed to address late referrals and treatment in community settings with little to no improvement, which often led to significant swelling and wounds in patients.
Traditional lymphoedema training was hindered by workload issues and insufficient confidence post-training. The programme focused on practical, hands-on education to improve staff competence and patient outcomes. Given the growing prevalence of lymphoedema, effective early treatment could reduce chronic wounds and hospital admissions, saving healthcare costs. OGEP aimed to enhance care quality, prevent waste, and improve patient-centred outcomes by training 500 community healthcare professionals from 2021-2024.
Methods
- Determined the how, when, who, and funding.
- "NO DATA=NO PROBLEM=NO SOLUTION" emphasised the importance of capturing baseline evidence and research.
- Held discussions with community nurses and service users
- Using the Managing Successful Programme Framework, created a business case and secured funding to pilot and test OGEP.
- Used PDSA cycles to increase community nurses' knowledge and skills in identifying and treating lymphoedema effectively, implement best practice management for patients, evaluated through improvements in nurses' confidence, competence, awareness, effectiveness of treatment, Patient Reported Outcome Measures (PROMs), and patient discharge rates. OGEP was adapted frequently, with formal education sessions, and robust guidance i.e 'Wet Leg Pathway’ (WLP).
Outcomes
- OGEP Embedded in six health boards
- OGEP educated 2,019 nurses, impacting care with improved knowledge and skills.
- Patient care improvements:
- 36% had increased compression levels
- 25% switched to compression garments, reducing nurse visits
- 19% received garments for proactive care
- Only 10% saw no change in care
- Within two months, 35% of patients were healed and discharged.
- Nurse feedback highlighted hands-on training and updated knowledge.
- Patient outcomes improved
- Staff competency/confidence improved
- Effectiveness/Efficiencies gained
- Financial gains
Learnings
- Middle managers focused on efficiencies over effective care.
- Data was key to demonstrating value.
- PROMs should have been included from the start.
- WLP developed for student nurses is valuable.
- Objective to educate 500 nurses surpassed due to low retention; ongoing education needed.
What next?
- OGEP, adaptable to all community nursing services.
- The WLP is adopted across the UK and translated into German.
- Raising awareness, recognising lymphoedema, and maintaining effective education are crucial.
