SUPPORTING AND ENCOURAGING

TEAM WORKING

Lewisham Foot Health Services

Integrated Wound Care Team

Ciaran Devlin (Foot Health & Orthotics Service Lead)

Stephanie Brooks (Home Visiting Service Manager & Wound Care Lead

Issues / Barriers

Commissioning of services

Increasing demand and complexity of wound caseload

Podiatrist role changing

Specialist workforce skills in Acute Foot MDT Team only

Stress levels in both teams

Poor referral flow between Community and Acute Foot Teams

Communication barriers with District Nursing

Under developed links with social services

SUPPORTING AND ENCOURAGING TEAM WORKING

SUPPORTING AND ENCOURAGING TEAM WORKING

2007 -2009

Wound care caseload (38% increase)

17% in diabetic foot wounds

280% in heel pressure ulcers

20% in face to face contacts due to

increase in administration

400% in time required for

community wound care since 2004

Challenge: Remove the barriers to effective team work

• Prioritise & allocate resources to wound care

• Develop skills in the community

• Develop appropriate support structures & processes

• Develop communication & team work

SUPPORTING AND ENCOURAGING TEAM WORKING

Removing the barriers to effective team work:

• Integration of community and hospital

• Staff engagement & service redesign

• Prioritising resources

• Principle Podiatrist responsible for full pathway

• Establish wound care leads (joint hospital & community posts)

• Wound care leads responsible for complex cases and supporting staff

• Six month training placements in wound care

• Six week protected learning time

SUPPORTING AND ENCOURAGING TEAM WORKING

Developing support Structures for staff:

• Wound care leads working with & supporting band 5/6 staff

• Monthly caseload reviews (Principle Podiatrist & Wound care lead)

• Individual case reviews for the complex cases

• MDT case conferences for the most complex cases (including virtual case reviews)

• Team Supervision on ‘clinical issues’

• Case presentations

SUPPORTING AND ENCOURAGING TEAM WORKING

Improve communication and MDT work:

• Integration of community & Hospital IT

• Shared records (community & Hospital)

• Named wound care leads

• Joint visits with District Nursing and other HCP’s

• District nursing attending caseload review meetings

• Virtual case reviews with hospital MDT

• SOVA/Best interest meetings

SUPPORTING AND ENCOURAGING TEAM WORKING

SUPPORTING AND ENCOURAGING TEAM WORKING

100% increase in shared care patients

133% increase in referrals to Acute Foot Service

0

50

100

150

200

250

2011 2013 2014 2015

Wounds

Referrals

2007 -2014, 32% increase in diabetic population

but only

17% increase in diabetic foot wounds

Diabetes - major and minor amputations rates significantly below national average

Job done?

SUPPORTING AND ENCOURAGING TEAM WORKING