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