Best Practice in Wound & Lymphoedema Care in Low-Resource Settings

A Framework for the Development of Guidelines & Recommendations for Capacity Building at the Country Level

Guidelines Working Group Members: Erik Post, MD, Working Group Leader, Laura Bolton, PhD

Pierre Brantus, MD Hugh Cross, PhD, Pod.

Mary Jo Geyer, PhD, PT David Keast, MD

Rob Snyder, DPM

The Wound & Lymphoedema Best Practice Pathway1

Experience of Clinicians in Low-Resource Settings Evidence in Literature

Opinion of Experts in Low-Resource Settings

Synthesis of Information

1. Modified from Keast D and Orstead H. The Pathway to Best Practice, Wound Care Canada, Vol. 4, No. 1, 2006, Guest Comentary

Best Practice Guidelines

Practice Recommendations Educational Recommendations Org/Policy Recommendations

Curricula & Training MaterialsReference Guides

Algorithms

Patient Risk Factors Local Resources

ID & Modify Barriers ID & Promote Bridges

Best Practice in Low-Resource Settings

Examples of Key FeaturesWound & Lymphoedema Best Practice Pathway1

Experience of Clinicians in Low-Resource Settings Evidence in Literature

Publications & Project Reports Low-Resource Settings

WHO White Paper

1. Modified from Keast D and Orstead H. The Pathway to Best Practice, Wound Care Canada, Vol. 4, No. 1, 2006, Guest Comentary

Modified Best Practice Guidelines

Practice Recommendations Educational Recommendations Org/Policy Recommendations

Curricula & Training Materials: ILEP, GAELF, IDFPatient & Provider Quick Ref Guides: CAWC

Validated Algorithms: VUCI, PUCI, etc.

Patient Risk Factors Local Resources

ID & Modify Barriers ID & Promote Bridges

Best Practice in Low-Resource Settings

Project Planning & Implementation

Don’t confuse guideline development with planning processes and/or operational activities for building capacity in wound and lymphoedema services

Framework for Planning

1. Perform a thorough situation analysis

• Conduct a site visit

• Review existing health system structure

• Review existing practices

• Compare existing practices to current best practices

• Standardize curricula, training materials & references

• The guidelines drive this process!!

Framework for Planning

1. Perform a thorough situation analysis (continued)

• Establish priority needs

• Identify local champions

• Identify “bridges” to the health care system

2. Identify potential interventions

3. Define indicators & monitoring tools

4. Define all steps: quantify targets & timelines

Framework for Planning

5. Identify tools for supervision

6. Select approach for community involvement

7. Identify resources for initial implementation

8. Develop a strategic plan

9. Develop an operational plan

Implementing an Operational Plan

1. Select priority area for implementation

• Set level of implementation

• Complete a focused situation analysis: emphasis on available resources, literacy, language, local support, active partners

2. Implement Operations

• Social Mobilization

• Training

• Related activities

Implementing an Operational Plan

3. Build on existing community interventions

• Define roles to strengthen links & coordination with partners

• Community Health Centers

• Outreach services

• Self-care groups

Implementing an Operational Plan

4. Link the program to the community & the health system

• Provide regular feedback to the community RE progress on outcomes

• Periodically review priorities & experience in implementation through evaluation & monitoring

• Provide follow-up & supervision of providers

• Promote services

5. Improve access to quality wound & lymphedema care