HNY Policy and Pathway Repository - Humber

City Healthcare Partnership CIC (CHCP) and Hull University Teaching Hospital ( HUTH) have worked together to implement the National Wound Care Strategy Programme ( NWCSP) lower limb recommendations by making changes to the previous lower limb pathways

The Hull and East Riding Lower Limb Pathway ensures patients receive an initial assessment undertaken by a clinician with advanced wound care capabilities / competencies and that they are commenced on the most appropriate treatment and referred to the most appropriate specialist without delay

The clinicians work within a mutli-disciplinary team system which allows rapid and direct access and referral to the Vascular team within HUTH, without the need to follow the standard and normal GP referral pathways 

Ideally patients should be encouraged to attend a Lower Limb Pathway 1st Assessment appointment within a Treatment Room setting

The pathway is available for any patient with a wound / ulcer / break to the skin below the knee

NB: Diabetic patients with ulcerated / foot concerns will continue to be fast tracked to the MDT within the Allam Diabetes Centre, Hull

• Wounds  / ulcers which have been present below the knee and on / above the malleolus  for 14 days or more should be referred immediately
• Wounds  / ulcers where it has  not been possible to implement ‘Immediate and Necessary Care’ should be referred immediately
• Wounds  / ulcers which are present below the malleolus  / on the foot at first presentation should be referred immediately 

Exclude Red Flag Symptoms

All the below should be treated / referred following current pathways prior to referral to the Lower Limb Pathway  

RED FLAGS

• Acute infection of leg or foot (e.g. increasing unilateral redness, swelling, pain, pus, heat).
• Symptoms of sepsis
• Acute or chronic limb threatening ischaemia
• Suspected acute deep vein thrombosis (DVT).
• Suspected skin cancer

Do Not Refer

• Patients without a wound - consider referral to Lymphoedema if appropriate  / or normal podiatry pathways via email or NHS eReferrals
• Wounds which are not on the lower limb below the knee – usual referral pathways and criteria should be followed
• Wounds which require urgent / emergency  / ‘first aid’ treatment – usual referral pathways and criteria should be followed 

Wherever possible practices should follow the NWCSP Lower Limb recommendations for ‘Immediate and Necessary Care’

NB: For all referrals, please indicate clearly on the referral form the exact location of the wound to assist CHCP Care Coordination staff to allocate patients to the correct clinic.  If patients have an ulceration to the foot and leg please refer into the appropriate FOOT ULCER team in the first instance

LEG ULCER:

When to refer leg ulcers -  i.e. wounds below the knee and on / above the malleolus:

• All wounds / ulcers where NWCSP recommendations of ‘Immediate and Necessary Care’ have not been met must be referred
• All wounds / ulcers which have been present, and / or remain unhealed at 14 days or more must be referred
• All wound / ulcers where the referred is concerned that healing will not take place by 14 days duration may be referred

Expected outcome - patient will be offered an appointment at the next available 1st Assessment Clinic which will be within 10 days of referral at the very latest, clinics are available throughout the Hull and East Riding areas

How to refer:

Via NHS eReferrals:

• CHCP Hull Treatment Room
• CHCP Nursing and Conditions - Hull  
• CHCP Nursing and Conditions – ER (including Treatment Rooms)

Or via phone:

• CHCP Care Coordination Hub on 01482 247111

FOOT ULCER:

When to refer foot ulcers - wounds below the malleolus:

All foot wounds should be referred within 24 hours of identification - this includes diabetic and non-diabetic

Expected outcome:

• Diabetic patients will be offered an appointment at the Allam Diabetes Centre (formerly Brocklehurst Diabetes Centre) as per current arrangements
• Non- Diabetic patients will be offered an appointment to attend the next CHCP Treatment Room based 1st Assessment Clinic  

How to refer:

Via NHS eReferrals:

• CHCP Podiatry Service Hull or East Riding

Or via phone:

• DIABETIC ULCERATIONS: The Allam Diabetes Centre on 01482 311808 - leaving message if no answer

• NON-DIABETIC FOOT ULCERATIONS: CHCP Care Coordination Hub on 01482 247111 – select PODIATRY option ‘0’

Information To Include

• Past medical history
• Medications
• Wound history to include duration of wound / present or past treatments / how the wound occurred e.g. following trauma / surgery