Learning objectives 1. To have a clear understanding of how to - - PowerPoint PPT Presentation

Measuring, Ordering, Fitting and After-Care

for compression hosiery in the lower limb M-O-F-A

Learning objectives

1. To have a clear understanding of how to measure for compression garments correctly 2. To understand what is required to fill in a prescription form correctly when ordering garments 3. To be able to teach your patients/carers the correct application of the garment 4. To know what after-care is recommended for patients and garments alike

Understanding how to choose which type of compression to use (1)

• Patient history
• Differential diagnosis — venous, arterial, mixed aetiology?
• Doppler signals / ABPI
• Clinic protocols
• British Lymphology Society (BLS) guidelines

Understanding how to choose which type of compression to use (2)

• What are the individual patient/healthcare professional goals?
• What pressures are likely to be needed to achieve these?
• What stiffness is likely to be needed to achieve these?
• What are the patient’s/carer’s circumstances and ability to apply what is

required?

• Remember your personal competences

Understanding compression — considerations

• How are garments made to get the pressures and tensions

they apply?

• How do manufacturers test their garments to a recognised

standard?

Circular-knit and flat-knit garments

• 2. Elastic

circular knit / mesh with inlay yarn

• 1. Elastic

circular knit / mesh

• 3. Flat-knit

weave fabric and inlay yarn

• Components to

consider are the type and mix of yarns, and the manufacturer’s weave of the garment/fabric

Elastic Inelastic

Pressures and tensions

Circular- and flat-knit garments

• The body yarn (A) of these together make up

the ‘thickness’ and ‘stiffness’ of the product

• The inlay yarn (B) is responsible for the

compression pressure

• Together, they give the total

prescription/overall ‘dose’ of what is required, e.g. compression and soft/stiff garment

S.T.R.I.D.E. Supplement. JWC. 2019.

BODY YARN A INLAY YARN B

Compression level chart

Compression level chart

Compression level chart

Compression level chart

Manufacturer pressure testing

• When a garment says it is between 20–30mmHg it is tested using

apparatus known as a Dynamometer (generic name)

• There are a number of these, common ones used are HATRA and

HOSY machines

• These are then translated into RAL/European/British/AFNOR, which we

commonly hear referred to as test norms / standards

• No one is better than the other, as it is a manufacturing test, not a

‘highest/best’ pressure test

Measuring O.F.A

Know what you are measuring for….

• Off-the-shelf or standard
• Made-to-measure (M2M) — circular- or flat-knit
• Consider the SHAPE of the limb

Remember: when choosing the style, e.g. below-knee or thigh-high, where possible always take the garment above the oedema/swelling Consider patient choice: open / closed toe / grip top etc

Measuring for standard size

Circumference measurement positions: cG - Thigh (2cm below gluteal fold) cD - Narrowest point approx. 2– 3cm below the knee cC - Widest part of the calf cB - Ankle (narrowest point above ankle bone)

Measuring for made-to-measure

Circumference measurements positions: cG - Thigh (2–5cm below gluteal fold) cF - Mid-thigh for circumference cD - Narrowest point approx. 2–3cm below the knee cC - Widest part of the calf cB - Ankle 2cm above malleolus for circumference cY – Around heel with foot dorsi-flexed

Decisions when measuring

• What to do if someone fits into two or even three different

sizes?

• Which size do we choose?

Size decisions

• 20–30mmHg compression garment
• Ankle (cB) = 21cm
• Size range is 21–26cm
• Therefore, 20mmHg will be approximately exerted at the ankle

However…

• Ankle (cB) = 26cm
• Therefore, 30mmHg will be approximately exerted at the ankle

Size decisions

Below-knee garment example:

• Patient has normal ankle (B)
• Far end of calf spectrum (C)
• Out of range on top measurement (D)
• Consider wide calf option
• Alternative is to measure for a circular-knit made-to-measure garment

and don’t forget about length:

• Length of limb (short/standard/long)

What next?

• Once we have Measured and know what size, compression

class and type of compression, i.e. circular- or flat-knit

• We need to Order them

M.Ordering.F.A This can be done in two ways:

• Order direct from manufacturer/wholesaler — (DT price + VAT)
• Individual orders
• Stock holding of garments
• Prescription FP10/GP10 — (VAT exempt = DT Price and no

delivery charges)

Generating the prescription —what is needed?

Example stock item — circular-knit

• Brand – ABC British Standard
• Class – Class 2 (18-24)
• Colour - Black
• Style – Below knee, open toe
• Size - Large
• Quantity – 2 x pairs

Example stock item — prescription charges

British Standard Hosiery charge by items in box 1 box = 2 x garments 2 charges (£18) 4 x Prescription charges (£36)

Example stock item — flat-knit

• Brand – ABC M2M
• Class – Class 3 (34-46)
• Colour - Sand
• Style – Below knee
• Optional extras – 2 x closed toe, 2 x T-

heel

• Quantity – 2 x pairs

Example stock item — flat-knit

Lymphoedema garments category

• The garments ordered must be the

same (stock and MTM)

• Optional extras are part of the

garment

• Any charges (i.e. order two colours)

would incur additional prescription charges

• No limits on quantity

= 1 x prescription charge for 2 lymphoedema MTM garments

Don’t forget the back

• Ensure the back of the

prescription is clearly completed and marked if the patient needs to pay for their prescription, or if they are exempt

• If your patient is not exempt, the

NHS Prescription Prepayment Certificate can save them money

Challenges in getting the garment

• 57% of clinicians who

experienced problems caused by garments (hosiery) had been supplied incorrectly1

• 1. Survey results from 630 responses to a

JCN/GPN in Sept 2018/Jan 2019

Challenges in getting the garment

• 76% of clinicians estimated that

they have issues with waiting time and delays1

• 1. Survey results from 630 responses to a JCN/GPN

in Sept 2018/Jan 2019

Dispensing option 1

Local pharmacy:

• General dispenser for all FP10/GP10 prescription items
• Normally link to GP surgeries
• Patient can collect once the item(s) have arrived
• Offer advice in different areas

Dispensing option 2

Specialist dispenser, i.e. dispensing appliance contractor (DAC):

• Home delivery direct to any UK address or clinic
• Knowledge/expert advice
• Communication and a direct link to manufacturers
• Understanding of compression and double checking of measurements
• A wide choice of manufacturers
• Knowledge of charges in this area

M.O.Fitting.A

• So, let’s imagine by now we have measured, ordered and

received exactly what we asked for

• We need to ensure that the patient can fit the compression

garment and then apply it

Application aids

M.O.F.After-care

• How to wash
• How long to wear
• When to re-order

Washing instructions

Always follow the manufacturer’s guidelines which should be in the box or on the label

How long to wear

• Patient and clinician goals
• Throughout the day
• 24 hours
• Night-time compression

When to reorder

How often should the hosiery be replaced?

• Most manufacturers’ garments will last for a 100 washes
• Two pairs should be prescribed at once — one to wear, one to wash
• Both should be replaced after six months

When should the hosiery be reordered?

• Order before six months as they are OUT OF WARRANTY at six months
• In this time, the manufacturer will replace the garment if defects appear.

The manufacturer may ask for the garment to be returned before a replacement is issued

Summary —M.O.F.A

• Full vascular and differential

diagnosis​

• Accurate Measuring​
• Ordering — writing of prescription​
• Reliable quick supply and service
• Fitting — patient/carer application,

i.e. do they need an aid

• Aftercare to self-care
• Reminder — when do they need

their next assessment or garment?

Useful resources #TVN2gether

Daylong

Daylong is your KEY to fast and accurate dispensing for ALL compression hosiery

Call us on: 0800 195 0160 Email: prescriptions@daylong.co.uk

• r

Visit: www.daylong.co.uk

Partners

To access your

certificate

visit:

www.wct-live.co.uk/certificate

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