A survey of venous ulcer care in wound care practices in Gauteng
Bruwer, Febe Antoinette
MetadataShow full item record
Background: Venous leg ulcers are the most common type of leg ulceration, and prevalence seems to be increasing as the population ages and co-morbidities increase. Venous lower leg ulcers seem to be an underestimated and misdiagnosed chronic disease that has a significant socio-economic impact on the individual, as well as on the community and the health care system. Evidence-based care improves outcomes for patients suffering from this debilitating disease. Objective: The objective was to describe the current level of care within wound care practices in Gauteng according to the Donabedian structure-process-outcome quality improvement model. Method: Forty-eight facilities were selected randomly from wound care practices (both public and private) in Gauteng. Trained fieldworkers conducted structured interviews with care providers to assess infrastructure, human recourses, level of education, equipment available, policies and protocols. Within these facilities, patient files were randomly selected from patients who had previously presented with venous lower leg ulcers. One hundred and sixty files were audited by using a checklist to assess processes implemented and outcomes reached. Results: A lack of proper record-keeping made data collection challenging. A few important findings were deduced from this study. The facilities lack the necessary equipment to perform vital assessments. Hand-held Dopplers were available in 60% (n=48) of the facilities. Patients were attended to by clinicians with no formal wound care training, as 61% (n=48) of the personnel at the facilities indicated no formal wound care training. Although the majority of files (92%, n=160) indicated that an assessment tool was used, many of the elements thereof were not comprehensively done according to best available evidence. Pain, presence of varicose veins, previous treatment, and functioning of the calf muscle were assessed in more than 70% of the files. However, aspects such as smoking, body mass index and anaemia, which all play a major role in wound healing, were assessed in fewer than 30% of files. Distinguishing between superficial infection and deep infection seems to be a challenge, together with the overutilization of antimicrobials and antibiotics. Furthermore, 71% received compression therapy while the Ankle Brachial Pressure Index (ABPI) of only 30% was known. Outcomes were recorded fairly well at three weeks but declined towards completion of treatment. Conclusion: Quality of care could be measured by measuring structures, processes and outcomes. Accurate record-keeping is vital to obtain a view of the processes being followed and the outcomes being reached. From this survey, it was evident that clinicians providing wound care are not all trained in wound care, that best practice guidelines are not being fully implemented, and that the consequences may be detrimental to the patients, as a high number of amputations were reported.