Application Guide

DN treats initially, using LUTM system to complete a detailed assessment of the patient’s leg ulcer. This includes taking a digital photograph and accurately measuring the ulcer size using the telemedicine software. This allows an accurate evaluation of treatment and to predict when the ulcer should heal.

If healing is not on target, DN may send images and ask for advice from the Vascular Service: usually this is a Nurse. This electronic transfer using NHS.net and replies are within 24hours, if not immediate. Some patients never need to be referred and are managed by this method.

If the DN requires the patient to be seen in the One Stop Clinic, an electronic referral is sent with the clinical information including an image of the ulcer. This is received and noted within 24 hours. Until partial booking, the Clinic was able to provide an appointment within 2-3 weeks. Partial Booking has introduced a 4 week delay. It is hoped that direct booking under Choose and Book will return the waiting time to 2-3 weeks. If the referring nurse feels the patient does need to be seen urgently, then the clinic has 2 scheduled urgent slots.

On attending Clinic the patient has a full vascular assessment by the Specialist Nurse. This includes a Doppler ultrasound and if needed a venous or arterial duplex scan. If an ulcer is not venous it is not necessarily arterial. There are about 10 different causes or aetiologies for leg ulcerations including malignancies.

If the ulcer is arterial the patient will see the Consultant for treatment options. The patient may see the consultant even if the ulcer is venous because they can then decide if vein surgery is appropriate. A patient may also be seen by the consultant if it is felt that skin grafting or biopsies are necessary. Otherwise the treatment options are agreed by the Specialist Nurse and commenced.

The patient is booked to return for a review if needed and the clinical information is available to the DN via the LUTM software, immediately.

On going dialogue continues between the community and the specialist using the shared electronic record and message relay unction which both have access to via nhs.net.

Photo Page	Progress Graph
Assessment Page	Treatment Page
Letter Page	Case Load