This Signal relates to problems resulting from inappropriately or poorly applied compression bandages used in the treatment of venous leg ulcers.
A sample incident report reads:
“Patient admitted to hospital with bandaging in situ and this continued to be applied by ward staff. When the patient was reviewed by a Tissue Viability Nurse specialist the patient’s leg was found to be ulcerated consistent with over compressed bandaging.”
The use of high compression bandaging, with systems such as three or four layer bandages can significantly improve the healing process for venous ulcers. However patients with arterial disease are not suitable for this type of therapy due to the risk of the bandaging causing further arterial occlusion.
Healthcare staff applying compression bandages must be competent to assess patients and apply the bandages. Staff must ensure the appropriate techniques are used on the correct patient for the appropriate condition. The evidence is well established (see Effective Health Care Bulletin Aug 1997).
A further issue for consideration is that under-compression is ineffective and adds to the time to heal and therefore has implications for the patient’s quality of life.
A search of the National Reporting and Learning System (NRLS) database from 2004 to September 2010 revealed 158 incidents relating to compression bandaging, reported from both primary and secondary healthcare settings. Of these eight resulted in severe harm to the patient.
Concerns raised by the incident data include:
• poorly applied compression bandaging resulting in pressure damage;
• compression bandaging applied when not indicated and in some examples where Doppler readings indicated arterial disease;
• concerns about staff competency in compression bandage application;
• delay in review of patients with compression bandaging.
The above points all emphasise the need for suitable staff training and education, along with ongoing competency assessment, inpatient assessment and compression bandage application technique.
Please contact us with your initiatives to reduce risks in these areas.
Signals are notifications of key risks emerging from review of serious incidents reported to the NRLS and shared by the NPSA.