On January 25th, Wounds UK published the Best Practice Statement: Ankle Brachial Pressure Index (ABPI) in practice.
The authors, members of the expert working group comprised of consultant vascular surgeon, tissue viability specialist, lead nurse in tissue viability and consultant nurses, identified the measurement of the Ankle Brachial Pressure Index (ABPI) as a crucial element of holistic assessment, which can enable early intervention and thus improve patient outcomes. They confirmed that utilizing new technology [MESI ABPI MD] to optimize ABPI testing has been proven to improve assessment levels and resulting patient outcomes.
According to experts, the main advantage is that automated testing makes the process significantly quicker and simpler in practice. An accurate reading is produced within 1 minute, compared to approximately half an hour for the traditional Doppler method, including patient resting time. Calculation of the results is reliable and is not susceptible to potential human error.
The statement stresses out the importance of ABPI, addressing the challenges, the role of automated ABPI, successful implementation, and making the case [summary of the findings]. Below we present a brief summary of the first four.
1) The importance of ABPI
ABPI should be used to identify if the patient had the arterial disease in the leg. This is done by comparing systolic pressures in the arm and leg.
All patients with a lower limb wound, particularly those with a leg ulcer, should undergo ABPI testing, as should patients who are at high risk (e.g. due to diabetes or immobility) or presenting with lower limb-related changes.
ABPI assessment is not intended for the diagnosis of venous disease, but rather for the exclusion of significant arterial disease and therefore confirmation of safe practice. For example, to confirm that the use of compression treatment is safe (Wounds UK, 2016).
Patients who are being managed with compression therapy should have regular testing to ensure that their arterial status has not deteriorated. Subsequent assessments, incorporating ABPI measurements, should be completed at 3, 6 or 12-month intervals.
2) Addressing the challenges
While ABPI measurement is considered a vital part of an assessment, evidence has shown that it is not being conducted widely enough in practice. This has a significant effect on healthcare systems, patient outcomes, and costs.
The lack of early identification and assessment means that more human and financial resources are spent on mistargeted care and treatments that may not aid healing of the wound. This can lead to increased chronicity, infection and other complications, and a further increase in levels of intervention required (Mullings, 2018).
3) The role of automated ABPI
The role of automated ABPI focuses on the MESI ABPI MD and the findings of a recent quality improvement project (Dowsett and Taylor, 2018), recognizing numerous advantages of using the plethysmography-based automated measurement.
- reduces clinician time,
- releases staff and resources,
- simplifies the testing processes and increases staff confidence,
- increases the accuracy of results,
- is suitable in most care settings,
- and facilitates early detection of PAD.
4) Successful implementation
A recent quality improvement project (Dowsett and Taylor, 2018) focusing on improving venous leg ulcer assessment and management for housebound patients, identified lack of time and confidence to undertake ABPI assessments as one of the key challenges in care delivery. This issue was addressed by procuring ABPI MESI MD devices for the teams involved, which led to more patients being seen in shorter spaces of time, and thus improving assessment and targeted treatment rates of patients receiving appropriate compression therapy. Use of the MESI ABPI MD has also led to identifying patients on the caseload with PAD and appropriate referral of these patients to vascular services.
The project reached a conclusion that “… All patients with leg ulcers on the community nurses’ caseload had been reviewed by the tissue viability team and had specialist advice and support so that they had a differential diagnosis and were receiving compression therapy. The frequency of nurse visits reduced to once a week as patients were receiving appropriate compression therapy and therefore required a visit once a week.” (Dowsett and Taylor, 2018)
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About the publication
Best Practice Statement: Ankle brachial pressure index (ABPI) in practice is a brand-new publication coordinated by Wounds UK with the Expert Working Group with the objective of supporting practitioners to improve the assessment of ABPI in practice by:
- Explaining the value and importance of ABPI as part of a holistic assessment
- Describing the processes involved and underlying rationale, and summarising these as Best Practice Statements (BPS)
- Showing how correct assessment and utilizing new technology (MESI ABPI MD) to optimize ABPI testing has been proven to improve assessment levels and resulting patient outcomes
The Statement covers all aspects of the Ankle-Brachial Index and is divided into the following sub-sections: The importance of ABPI, Addressing the challenges, The role of automated ABPI, Successful implementation and Making the case.
References mentioned here are available in the original statement.