Journal of Community Nursing

58 JCN 2020,Vol 34, No 4 WOUND CARE I t is well recognised that chronic oedema is a symptom of underlying venous/lymphatic disease, or other conditions such as cardiac disease, etc. Unfortunately, this is not always recognised in the community, with patients with chronic oedema being managed inappropriately. The elderly population are sometimes not treated, as it is often considered just to be a part of old age. Prevalence of chronic oedema is high — on a par with other serious long-term conditions, such as stroke (Moffatt et al, 2017) — and is likely to increase with an ageing population and increased comorbidities. In 2003, Moffatt et al reported a prevalence of 1.33 per 1,000 people. However, Inappropriate use of diuretics and antibiotics for wet or ‘leaky’ legs Vivienne Murdoch as a result of a study carried out in an urban population in 2012, this increased to 3.93 people with chronic oedema per 1,000 (Moffatt et al, 2017). Moffatt et al (2019) also found an association between chronic oedema and patients having a wound — of the percentage of patients with chronic oedema in a community setting (between 52% and 69%), 73% also had a leg ulcer. Identification and health promotion at an early stage of chronic oedema can be life-changing to the patient and cost-effective in a culture of budgetary challenges. However, Vivienne Murdoch, tissue viability and chronic oedema liaison nurse, South Eastern Trust Northern Ireland Chronic oedema is a common condition which is increasing in prevalence, yet is still often under-recognised and mismanaged in community settings. Any oedema is a sign that the venous and lymphatic systems are not working properly. Without early identification and intervention, the condition can worsen, resulting in the need for complex care. Using a case history, this article highlights the inappropriate and ineffective use of medicinal management of a patient with lymphorrhoea (i.e. wet, ‘leaky’ legs). As a result of health assessment and a review of management and medication, deprescribing was effectively implemented in this case. The patient was provided with compression hosiery and education, and supported by a Healthy Legs clinic in the South Eastern Health and Social Care Trust, with positive outcomes for the patient, treatment room and GP. The case demonstrates how good practice uses health assessment and symptom analysis to determine diagnosis and appropriate treatment options. It also poses the question: is pharmacology always the answer? KEYWORDS:  ‘Leaky’ legs  Chronic oedema  Holistic assessment  Loop diuretics  Antibiotics in the author’s clinical experience, patients who attend tissue viability services have often already developed late signs of chronic venous and lymphatic disease with skin changes, infection (including cellulitis), lymphorrhoea (i.e. wet or‘leaky’legs due to lymph fluid leaking through the skin in grossly oedematous legs), or ulceration. All of which could potentially have been avoided with early diagnosis and intervention. NURSES’ ROLES AND UNNECCESSARY PRESCRIBING The role of the specialist nurse and independent prescriber is to ensure that those delivering care are aware of the importance of evidence-based practice being at the forefront of prescribing choices, and that unnecessary prescribing is minimalised. Indeed, management of a patient’s symptoms does not always require medicinal intervention. For example, without adequate understanding of the pathophysiology of chronic oedema, inappropriate pharmacological prescribing can occur, which can have a negative impact on patients. In the author’s clinical experience (and the rationale for the development of the Healthy Legs clinic discussed below), the common use of loop diuretics and antibiotics prescribed by GPs for the management of wet or‘leaky’ and red legs is ineffective and physiologically damaging to patients, with iatrogenic and side-effects, as well as drug interactions (Joint Formulary Committee, 2017). LOWER LIMB CONDITIONS AND LEARNING FROM A PATIENT HISTORY Chronic oedema Chronic oedema is an umbrella term to cover any form of swelling ‘Identification and health promotion at an early stage of chronic oedema can be life- changing to the patient and cost-effective in a culture of budgetary challenges.’