SMASAC Short Life Working Group on Lymphoedema - Lymphoedema Care in Scotland, Achieving Equity and Quality
A Scottish Medical and Scientific Advisory Committee Report. Providing information on the nature and extent of Lymphoedema. Making recommendations for Scottish Government Health and Social Care Directorate, Health Boards, NHS Education Scotland and Healthcare Improvement Scotland
Appendix 7: Workforce Competencies and Educational Requirements
Table 1
| Key outcomes to be achieved |
Reduce incidence, severity and complications, ensure early diagnosis, support self management and enhance quality of life |
|
|---|---|---|
| Members of the health and social care team responsible |
Suggested competencies |
Educational requirement in relation to lymphoedema |
| All registered health care professionals (HCPs) in all settings |
Identify individuals who are at risk of lymphoedema Advise on general and specific lymphoedema risk reductions strategies Recognise signs of early lymphoedema Recognise signs of cellulitis and refer for assessment and treatment promptly when suspected Direct individuals to appropriate information and resources Be sensitive to concerns and understanding of needs Support individuals to manage their own care as far as they are able |
Short term:
Long Term: Basic information integrated at key points in UG education for all HCPs on: lymphatic system, its function re lymphoedema, who is at risk, what they can do to minimise risk, clinical signs of lymphoedema and cellulitis |
| Non-registered health and social carers, particularly in primary care or care of older people |
Implement skin care to protect its integrity and prevent cellulitis Reporting swelling or infection promptly Encourage movement and elevation of lower limbs when seated Support individuals to manage their own care as far as they are able |
Basic preventative care integrated into training |
Table 2
| Key outcomes to be achieved |
|
|
|---|---|---|
| Members of the care team responsible |
Suggested competencies |
Educational requirement in relation to lymphoedema |
| Lymphoedema champions particularly in primary care, elderly care and palliative care settings responsible for individuals with chronic lower limb oedema or requiring end of life care |
Recognise and treat chronic oedema of mixed origin (venous, lymphatic, multi-organ failure) Recognise and address treatable contributory factors Implement appropriate skin care, activity/positioning and education to minimise risk of infection, lymphorrhoea, ulceration and trauma Apply appropriate dressings and compression if swelling or lymphorrhoea develops Involve lymphoedema practitioners for advice on helpful strategies |
Short modules, possibly on-line or blended and as part of specialist palliative care courses Specific professional or context based on-line resources/podcasts e.g. for podiatrists Opportunities for experience of patients in a lymphoedema clinic with periodic updates |
Table 3
| Key outcomes to be achieved |
Routinely screen, monitor and support self management as part of an agreed prevention protocol OR as part of a long term maintenance programme, under supervision/support of an appropriately trained registered HCP |
|
|---|---|---|
| Members of the care team responsible |
Suggested competencies |
Educational requirement in relation to lymphoedema |
| Health Care Support Workers (HCSWs) Band 3-4 or registered practitioners in key roles/settings where there is increased risk or incidence of lymphoedema, e.g. in oncology OR where there is increased incidence of chronic oedema, e.g. in oncology , elderly care or primary care settings OR in a specialist lymphoedema clinic |
Provide specific Information and advice to at risk individuals or those with lymphoedema Measure limb volumes Undertake standardised assessment procedures Fit and replace compression garments in those meeting agreed criteria or those whose lymphoedema/chronic oedema is stable |
Short training module, blended online/face to face with mentorship and supervision until agreed level of competence achieved Periodic review of skills |
Table 4
| Key outcomes to be achieved |
|
|
|---|---|---|
| Members of the health and social care team responsible |
Suggested competencies |
Educational requirement in relation to lymphoedema |
| Lymphoedema Practitioner in particular settings/roles whose regular exposure to people with lymphoedema would allow development of confidence and competence, e.g. oncology, paediatrics, care of older people, dermatology, vascular services |
Comprehensive assessment of individuals with lymphoedema including assessment of limb volume and skin and tissue changes in order to stage it. Supervise HCSWs with a lymphoedema role Make decisions to refer for further investigations or more specialised treatment where required Support self management, monitor effects of treatment Liaise with Lymphoedema Specialist and refer on as required for advice and specialist treatment during periods of exacerbation/poor control of condition but taking lead role if condition is stable with optimum self management according to agreed pathway Ensure a multidisciplinary approach to maximise potential for self-care, e.g. weight management, social care, housing |
Recognised course - blended face to face, online and workbased with recognised qualification |
Table 5
| Key outcomes to be achieved |
|
|
|---|---|---|
| Members of the care team responsible |
Suggested competencies |
Educational requirement in relation to lymphoedema |
| General Practitioners and Consultants in specialties associated with higher prevalence of lymphoedema, e.g. oncology, vascular medicine, dermatology, cardiology, care of older people |
Recognise early signs of possible lymphoedema Refer for appropriate assessment or investigations and advice from specialist practitioners when appropriate Follow BLS guidelines or locally adapted protocols for treatment and prevention of cellulitis |
Awareness of clinical features and progression of lymphoedema Awareness of cellulitis treatment and prevention protocols Awareness of principles of treatment of lymphoedema and how to access treatments Information integrated into key points of UG curriculum. Short term need for awareness raising, possibly through online module |
Table 6
| Key outcomes to be achieved |
Equitable provision of lymphoedema services |
|
|---|---|---|
| Members of the care team responsible |
Suggested competencies |
Educational requirement in relation to lymphoedema |
| Lymphoedema Specialist Practitioner* |
Manage all types of complex or unstable lymphoedema with degree of autonomy and responsibility for own caseload within an MDT context Supervise and guide/advise other HCPs and HCSWs Selected services/practitioners should accept referrals for treatment of children or act as consultants to paediatric services |
Degree level education plus specific qualification in specialist lymphoedema management Opportunity to gain clinical experience in treatment of children with lymphoedema |
| Lymphoedema Advanced Practitioner* |
Manage and lead developments of lymphoedema service while having a key clinical and educational role Support and act as a resource for lymphoedema practitioners and specialist practitioners |
Highly developed clinical professional and theoretical knowledge to at least Master's level Recognised qualification in Specialist/Advanced Lymphoedema management Training in comprehensive clinical examination skills |
| Clinical Leads/Case Managers in MDT |
Ensure lymphoedema practitioners are involved/consulted as part of an MDT approach to managing care for people with complex lymphoedema or lymphoedema alongside other co-morbidities. |
Awareness of the principles of lymphoedema treatment and risk reduction strategies Online education module |
*Most likely to be registered nurse, physiotherapist or occupational therapist
Contact
Email: Diane Dempster
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