An Evaluation of the JPUH Lymphoedema Service Garment Procurement Process

Christina Bater Lymphoedema Clinical Nurse Specialist & Service Lead. JPUH Research & Evaluation Scholar 2022/3
Christina.Bater@JPaget.nhs.uk
PROCESS
Background
For many lymphoedema patients, a
key element of treatment, is the Staff focus group Carried out with 3 lymphoedema specialists and 2
administration staff working with the JPUH lymphoedema team.
wearing of compression garments.
Recordings were analysed and key themes identified
At JPUH, following assessment by Time Cost
Risks for patient
our specialist practitioners, a implications for wellbeing
implications for
service NHS
request is made to the patient’s GP
to prescribe any required garments.
However, a significant number of Local practitioners questionnaire – 14 responses.
patients have reported receiving Do you experience issues with patients Do you experience delays in patients With dispensing appliance
incorrect items or experiencing long receiving incorrect items? receiving garments?
contractor
With pharmacy
delays before garments are Strongly disagree

Disagree
Strongly disagree

Disagree

received. Research is limited, but Neutral Neutral

- 6 commented on an
improved experience
consistent in it’s findings on this Agree

Strongly agree
Agree

Strongly agree
using ‘Patient Choice’ Implications
issue. Audits undertaken by Woods 0 1 2 3 4 5 6 7 0 1 2 3 4 5 6 This data indicates that patients are at risk of
(2018), Board & Anderson (2018) harm with the present procurement process.
and Thomas et al (2021) all show Review of 3 months of incidents log Prolonged delay
The majority of issues relate to involvement of
similar experiences with GPs pharmacies. Options for improvement include a
IN 25% Never received
prescribing and community hospital based budget for procurement,

STAGE 1 OUTCOMES
OF ORDERS 29 Prescribing problems
pharmacies supplying garments. AN ISSUE WAS PATIENTS prescriptions being made via dispensing
Incorrect item supplied
LOGGED appliance contractor or training of all community
Manufacturing error
and GP based pharmacy staff.
Aims
2 patients never received
- To ascertain if there is a problem 2 week snap shot of orders process = 14 their garments
orders
with the current procurement TIME FROM Next steps
TIME FROM TIME FROM TASK
process REQUEST TO TASK TO PRESCRIPTION
PRESCRIPTION TO It is proposed that for stage 2 of this quality
RECEIPT improvement project, a trial be undertaken with
- To identify the cause of any Median same day Median 1.5 days
Median 27.5 days
problems Range 0 – 7 days Range 0-21 days
Range 14-42 days prescriptions being made via a dispensing
- Understand their impacts appliance contractor. To trial initially for 2
- To identify potential strategies to weeks, and if no concerns or issues identified, to
improve the process Interviews with affected patients Semi structured interviews used. then continue for a further 3 months. Data to be
Recordings were subsequently reviewed and key themes identified. collected and compared with that collected
Acknowledgements Emotional Worsening of Extra Social during this phase of the project, to evidence if
impact lymphoedema appointments impact
Many thanks to the JPUH lymphoedema team, anticipated improvements are achieved.
regional BLS colleagues and patients who shared
their experience and feelings on this subject. Many “I’d had all this treatment and now things were getting
progressively worse again, and I get that that … we were References
thanks also to the amazing JPUH scholarship team Board. J, Anderson. J (2018) Improving patient access to compression garments: an alternative approach Journal of Lymphoedema 13 (1): p
and my manager Bev Chilson for your ongoing working with the garments we had, but it really had a 54-58.
Thomas. M, Morgan. K, Humphreys. I, Newton. R (2021) Changing the process of prescribing to procuring lymphoedema compression
support and encouragement with the project. mental health impact.” garments Journal of Prescribing Practice 3(12): p 490-498.
Woods. M (2018) Audit cycle of the provision of compression garments on prescription British Journal of Nursing 27(15): p 869-875