PRIMARY AND SECONDARY CARE INTERFACE

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The aims of this essay are to follow an episode of treatment related to one patient that I worked with during my practice placement. To meet the aims I have decided to write about a female patient I met, who due to patient confidentiality I will call Nellie, whilst on placement with a District Nurse in a rural area of South Herefordshire. The main body of this essay will concentrate on the aspects of wound care that were applied to Nellie’s wounds which were two very black necrotic heels which she acquired during a spell spent in both the main city hospital and whilst having rehabilitation care at the more local cottage hospital.
Nellie is an 84 year old lady, who as I have already said lives in a rural community in South Herefordshire, she is a widow and lives alone in an adapted bungalow with her son living close by and with a carer supplied by social services that visits twice a day. Otherwise normally fit and healthy Nellie had a fall at home and suffered with a fractured neck of femur which saw her admitted to hospital, here she had some complications with her injury and also acquired a chest infection along with the first necrotic heel. Nellie was then transferred to a local cottage hospital for help with rehabilitation where she acquired the second necrotic heel. Both the heels were being dressed once a week in accordance to an assessment that was carried out by the Tissue Viability Nurse for the area who covered both primary and secondary care facilities, but no up to date assessment had been carried out prior to discharge.
Nellie arrived at home and was referred to the District Nursing team via the Discharge Liaison Service, who act as an interface between primary and secondary care teams, as part of the more wider Multi-Disciplinary Team, to ensure that everything is in place to aid the patient upon discharge and thus make it an effective one. The
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