Lymphoedema Service Update Gillian McCollum / Pippa McCabe Lymphoedema Clinical Leads.
-
Upload
egbert-weaver -
Category
Documents
-
view
229 -
download
4
Transcript of Lymphoedema Service Update Gillian McCollum / Pippa McCabe Lymphoedema Clinical Leads.
Lymphoedema Service Update
Gillian McCollum / Pippa McCabe Lymphoedema Clinical Leads
Belfast Trust
Who are we?
Predominantly outpatient service
3.2 WTE clinical staff
Admin support/therapy assistant just appointed (vacant since Feb 2009)
Clinical Lead coordinates & develops the services in SEB & NWB – 0.5 WTE clinical & 0.5 WTE non clinical
Belfast Trust
Lymphoedema Specialists
South & East Belfast Service:
Jill Lorimer (0.7 WTE)
Diane Stronge (0.5 WTE)
Louise Kerr (0.5 WTE)
North & West Belfast Service: Emma Christie (0.5 WTE) Tanya Coppel (0.5 WTE)
Belfast Trust
Where do we see patients?South & East Belfast: Cancer Centre, BCH Holywood Arches Centre Domicillary
North & West Belfast: Ballyowen HC Carlisle HWB Centre Grove HWB Centre Domicillary
South Eastern Trust
Who are we?Service commenced Feb 2008, consisting of:Pippa McCabe – Clinical Lead (0.8 WTE)Laura Patterson – Lymphoedema Specialist (1.0 WTE)
We also have other lymphoedema trained physiotherapists in the trust who treat specific groups of patients:Janet Gabbey (oncology in-patients)Lesley Nelson (palliative care)
South Eastern Trust
Where do we see patients?
Ards Community Hospital
Bangor Health Centre (although less regularly)
Marie Curie Centre Belfast
Lagan Valley Hospital Downpatrick – Pound
Lane Health Centre
Ards Community Hospital
Bangor Community Hospital
Ulster Hospital Lagan Valley Hospital Downpatrick Hospital Downshire Hospital
Out-Patients In-Patients
Specialist palliative care service in the community, NI hospice, Marie Curie & acute oncology service in the cancer centre also treat some lymphoedema patients
Those patients who have chronic skin and/or wound issues may be treated in conjunction with TVN, practice nurses or district nurses
Involve wider multidisciplinary team as necessary – GP, dietician, podiatry, OT etc
Other services
Who do we see?
Primary lymphoedema patients Congenital abnormality of lymphatic
system Can be hereditary May be associated with a syndrome, for
example:Syndrome Name Age of Onset
Milroy’s Disease Birth/Childhood
Turner’s Syndrome Birth/Childhood
Meige’s Syndrome Puberty
Who do we see?
Secondary Lymphoedema Patients obstruction or interruption of the lymphatic system by
an external causeTrauma and tissue damage
Lymph node excision
Radiotherapy
Burns
Varicose vein surgery/harvesting
Large/circumferential wounds
Malignant Disease Lymph node mets
Infiltrative Carcinoma
Lymphoma
Pressure from large tumours
Inflammation Rheumatiod Arthritis
Psoriatic arthritis
Dermatitis/eczema
Immobility and dependency
Dependency Oedema
Obesity
Paralysis
Venous Disease Chronic venous insufficiency
Venous ulceration
DVT
Artificial Lymphoedema
Self harm
Low albumin
Infection Cellulitis
Lymphadenitis
Filiariasis
(CREST 2008)
What services do we provide?
Advice and information on skincare and exercise
Manual Lymphatic Drainage Multi-Layer Lymphoedema Bandaging
What services do we provide?
Compression Garments Kinesio taping Teach patient & their carers self
management techniques 6 monthly review appointments Access to a quarterly complex clinic with
involvement from dermatology, vascular and palliative care consultants
Other roles & achievements
Education – trust programme; pre & post graduate training; courses; advice booklets etc
Belfast Trust Lymphoedema Network - partnerships with relevant specialities such as vascular, dermatology, oncology etc
Facilitating implementation of cardiovascular & cancer service framework standards
PR campaign – Belfast Telegraph (Nov 2009) Research Clinical Minimum Data Set Engagement with PPI
For further details see www.lnni.org
Waiting list
Increase in rate of referral Must meet access targets of 9 weeks Increase in complexity of cases Length of intensive treatment required
varies greatly from 2 weeks – 6 months 6 monthly reviews
Variety of Lymphoedema Cases
Simple Arm Lymphoedema Complex Leg Lymphoedema
Concerns & Issues
Major reforms within health service Funding Efficiency savings Recruitment Lack of dedicated treatment space Limited capacity of lymphoedema
service
Solutions to the issues??
Raise profile of lymphoedema & lobby at Stormont – but need to be realistic
Raise awareness – patient & professional education
Promote early diagnosis & referral → less intensive treatment required for acute stage of condition
Empower patients & their carers to self manage this chronic condition