Leg Clinic/Clubs Policy

Leg Clinic/Clubs Policy Policy Number: 416 Supersedes: - Standards For Healthcare Services No/s 3,8,10 Version No: Date Of Review: Reviewer Name: Completed Action: Approved by: Date Approved: New Review Date: 0.2 September 2014 Jane James 3 years 0.3 January 2016 Brief Summary of Document: This document sets out the operational policy for venous leg clinics/clubs within Hywel Dda University Health Board To be read in conjunction with: 008 - Consent to examination or treat Policy Classification: Clinical Category: Policy Freedom Of Information Status Open Authorised by: Job Title Director of Nursing Services Signature:

Responsible Officer/Author: Contact Details: Jane James Claire Hurlin Job Title: Dept Tissue Viability Base GGH Tissue Viability Lead Nurse Head CCM Tel No 01267227761 E-mail: Jane.james2@wales.nhs.uk Scope ORGANISATION WIDE DIRECTORATE DEPARTMENT ONLY COUNTY ONLY Staff Group Administrative/ Estates Medical & Dental Nursing Allied Health Professionals Ancillary Maintenance Scientific & Professional Other CONSULTATION Please indicate the name of the individual(s)/group(s) or committee(s) involved in the consultation process and state date agreement obtained. Individual(s) Group(s) County lead community nurse Podiatrist Date(s) October 2014 November 2014 Tissue viability team Leg ulcer task group Date(s) October 2014 Committee(s) County Head of Community Nursing Date(s) December 2014 RATIFYING AUTHORITY (in accordance with the Schedule of Delegation) NAME OF COMMITTEE Clinical Policy Review Group A = Approval Required FR = Final Ratification A KEY Date Approval Obtained COMMENTS/ POINTS TO NOTE Date Equality Impact Assessment Undertaken 22/12/14 Group completing Equality impact assessment Jackie Hooper, Equality and Diversity advisor Jane James, Tissue Viability lead Nurse Claire Hurlin, Chronic Conditions Manager Please enter any keywords to be used in the policy search system to enable staff to locate this policy Wound Care; leg ulcer; leg clinics; Leg club Database No: Page 2 of 17 Version 0.3

Document Implementation Plan How Will This Policy Be Implemented? Who Should Use The Document? What (if any) Training/Financial Implications are Associated with this document? Usual policy distribution channels to appropriate areas Available via the HDUHB intranet All professionals attending leg Clinic/club including nurses, health care support works, volunteers and therapy staff Implementation of clinic/clubs and associated costs attached to this including provision of vascular assessment equipment, camera and dressing stock Additional human resource to staff leg clinic/club Action By Whom By When What are the Action Plan/Timescales for implementing this policy? Operational Policy to be drafted Gwenda James August 14 Implementation directed by service need Primary care Board Ongoing Database No: Page 3 of 17 Version 0.3

Contents 1. INTRODUCTION... 5 2. POLICY STATEMENT... 5 3. SCOPE... 6 4. AIM... 6 5. OBJECTIVES... 6 6. KEY PRINCIPLES OF COMMUNITY CLINIC/LEG CLUB... 6 6.1. PATIENT ASSESSMENT... 6 6.2. INVESTIGATIONS... 7 6.2.1. UNDERTAKING AN ANKLE/ TOE BRACHIAL PRESSURE INDEX... 7 7. CLINIC ARRANGEMENTS... 8 7.1. OPERATIONAL ARRANGEMENTS... 8 7.2. REFERRALS... 9 7.2.1. REFERRAL TO THE CLINIC... 9 7.2.2. EXCLUSION CRITERIA... 9 7.2.3. REFERRAL FROM THE CLINIC... 9 7.3. INTER PROFESSIONAL COMMUNICATION... 9 7.4. CLINIC FACILITIES... 10 7.5. HEALED CLINICS... 10 8. ROLES AND RESPONSIBILITIES... 10 8.1. DIRECTOR OF PRIMARY, COMMUNITY AND MENTAL HEALTH CARE... 10 8.2. COUNTY DIRECTORS... 10 8.3. THE COMMUNITY HEAD OF NURSING... 10 8.4. THE SENIOR SISTER/TEAM LEADER... 10 8.5. THE CLINIC LEAD NURSE... 10 8.6. THE TISSUE VIABILITY TEAM... 11 8.7. ALL HEALTHCARE PROFESSIONALS WORKING IN THE VENOUS LEG CLINICS/CLUBS... 11 8.8. HEALTH CARE SUPPORT WORKERS... 11 8.9. VOLUNTEER... 11 9. TRAINING... 12 9.1. PATIENT AND CARER INFORMATION... 12 10. AUDIT AND EVALUATION... 12 11. IMPLEMENTATION... 12 12. FURTHER INFORMATION... 13 13. REFERENCES... 13 14. APPENDIX 1 LEG ULCER PATHWAY DOCUMENT... 14 15. APPENDIX 2 - VOLUNTEER ROLE DESCRIPTION... 15 16. APPENDIX 3 PATIENT INFORMATION... 17 Database No: Page 4 of 17 Version 0.3

1. INTRODUCTION A chronic leg ulcer can be defined as a breach in the epithelial integrity of the skin which occurs between the ankle and the knee and present for over six weeks (De Silva,2012). It is estimated that 0.1% of the British population suffers with debilitating chronic leg ulcers (Sarkarz & Ballantyne, 2000) and this is associated with high cost in terms of finance and quality of life (King, 2012). It is suspected that the financial cost of leg ulceration to the NHS in the United Kingdom is between 300m - 600m (Simon & McCollum, 2004) with much of this associated with the delivery of care as provided by the nurse in the community environment (Wasek, 2013). Reports of pain, lack of sleep, immobility and social isolation are common symptoms that impact upon the patients quality of life that cannot be measured in financial terms. The importance of undertaking an accurate holistic patient assessment cannot be underestimated in the management of leg ulceration and assessment is an essential component in ensuring realistic and appropriate care planning (Hampton and Collins, 2004;). Furthermore establishing the aetiology of a leg ulcer and identifying factors that influence the healing process are key to effective management (Hampton & Collins, 2004; Moloney, 2004) including consideration of the patients co-morbidities, lifestyle factors, symptom management, compliance to treatment and the availability of resources (White et al 2011). Some patients may require vascular and/or medical intervention for which a timely intervention is crucial and a delay in diagnosis can be profound. Lack of communication between services and disciplines can undermine patients confidence. In recent years, scientific and medical advances, demographic changes and improvements in the understanding of wound aetiology have had an impact on the community nursing management of leg ulcers (Lindsay, 2008). The development of an integrated care pathway provides a structured multidisciplinary plan of care that details essential steps in the care of patients with a specific problem (Campbell, 1998). They are aimed at facilitating the introduction of guidelines into clinical practice by providing the link between the establishment of clinical guidelines and their use and also the provision of communication with the patient by giving them access to written summary of their expected care plan.. The development of a specialist leg ulcer clinics/club incorporating the use of a Hywel Dda University Health Board s (the Organisation) Leg Ulcer Pathway (Appendix 1) is aimed at optimising the care of the patient with leg ulceration by providing appropriate clinicians with assessment and management guidelines and appropriate referral pathways to promote a collaborative working relationship with other services provided by the Organisation to help reduce the incidence and severity of wounds. 2. POLICY STATEMENT The purpose of this policy is to set out a framework for the assessment and management of patients with leg related problems including swollen legs and ulceration who attend community leg clinics/clubs to provide clear guidance on the roles and responsibilities of maintaining a evidence based leg ulcer management across all three counties in the Organisation. The level of service may vary in the three counties as it is dependent on resource. It is recommended that community nurses work together with practice nurses to ensure all remain competent in the care of people with leg ulcers. Database No: Page 5 of 17 Version 0.3

3. SCOPE This policy outlines the responsibility of all staff members involved in the provision of care for the patient with leg ulcers within the community leg clinic/club. 4. AIM The aim of this policy is to provide research based guidance to ensure a consistent approach to the care of patients with leg ulcers in the community clinic/leg club setting. 5. OBJECTIVES To provide a framework for the management of the patient with leg ulcers within the community clinic/leg club setting to ensure; A holistic and standardised approach to leg ulcer assessment. Appropriate use of resources through engagement with the multidisciplinary team and third sector parties. The promotion of a positive attitude to enhance patient motivation, self management, compliance and independence. Timely referral to other specialities if required. The community leg clinic acts as a teaching resource and provides an environment for staff development. Facilities to perform post healing monitoring and well leg checks to help prevent recurrence. 6. KEY PRINCIPLES OF COMMUNITY LEG CLINIC/CLUB 6.1. PATIENT ASSESSMENT Every leg ulcer will have an underlying aetiology that requires accurate diagnosis to facilitate rational decision making to ensure the most appropriate intervention can be planned. Good quality patient assessment can save time and costs through reducing inappropriate treatment regimens (Newton, 2010). Previous ulceration, treatments, preventative strategies and allergies need to be taken into account in order that appropriate management can be planned. (RCN, 1998). The practitioner caring for an individual with leg ulceration needs to consider the patients knowledge, physical and mental capacity and language barriers to encourage concordance and adherence to treatments and instil confidence. Assessment should be ongoing as signs and symptoms can change and nurses need to monitor the impact of their interventions and evaluate progress. The assessment must be holistic and include information regarding lifestyle in its approach and encourage patient involvement in the decision making process. The assessment will acknowledge cultural beliefs with particular regard to the removal of clothing for assessment purposes. The choice of bandage therapy should also be considered as some forms of religious worship require individuals in barefoot for prayer. Cultural beliefs will also be acknowledged when prescribing dressing regime as some dressing materials contain animal products such as pectin. A full clinical history and examination of the lower limb is conducted for any patient that presents with either their first or a recurrent leg ulcer. (SIGN 2010). Database No: Page 6 of 17 Version 0.3

This assessment will include: Completion of HDUHB leg ulcer pathway to include: Patient history Assessment of vascular status to include patient history of rest pain and claudication palpation of pulses, ankle brachial pressure index (ABPI) or Toe Brachial Pressure Index (TBPI) for patients with diabetes, Neurological status including cutaneous sensation. Consideration of factors such as infection, diabetes, malnutrition and medication as these may also contribute towards delayed healing. Characteristics of limb shape, size and appearance Wound associated pain Key patient objectives for management Assessment of the wound at each clinic appointment to be recorded on HDUHB wound assessment form to include; Location of the wound. Wound dimensions recorded either by tracing the wound or through photograph. Consent for wound photography should be obtained using the All Wales consent policy (number 7) Duration and onset of the wound. Wound bed and margins. Exudate levels. Pain levels Condition of the surrounding skin. 6.2. INVESTIGATIONS 6.2.1. Undertaking an Ankle/ Toe Brachial Pressure Index Measurement of the Ankle Brachial Pressure Index (ABPI) must be part of the patient s holistic assessment and always be completed before the application of any compression therapy (excluding patients under the management of specialist Lymphoedema team who may decide an ABPI assessment may not be appropriate) Measurement of ABPI should be performed by appropriately trained practitioners. Care must be taken in interpreting ABPI results in patients with heavily calcified vessels, such as in some patients with diabetes and advanced chronic renal failure, where they may be misleadingly high. The presence of diabetes is associated with the premature and rapid development of artherosclerosis and is a major risk factor associated with peripheral arterial disease. In these instances it is recommended that practitioners also measure the Toe Brachial Pressure Index (TBPI) as calcification rarely affects the arteries of the toe. (Moffat et al, 2007) For ABPI values above 1.2, the vessels are likely to be incompressible, and the result cannot be relied on to guide clinical decisions. Patients with an ABPI of <0.8 or TBPI <0.65 with critical ischaemia or disabling claudication should be referred for specialist vascular assessment. (SIGN, 2010). For ABPI a minimum of two pulses is required for a safe diagnosis. Database No: Page 7 of 17 Version 0.3

7. COMMUNITY LEG CLINIC ARRANGEMENTS 7.1. Operational arrangements Premises chosen should be suitable for the provision of treatment of patients with leg ulcers, including the implementation of the standards for infection control and the safe disposal of contaminated waste. If clinics are in isolated situation then assessment should be completed locally to determine if the lone worker policy applies The clinic will be held at least once a week. Appointments will be managed by the individual leg clinic/club nurses. The venue and facilities at each clinic will determine the availability of clinic time slots and if the clinic will have an open access philosophy. The venue and facilities will also determine if patients are treated in communal or individual clinical areas. All new patients will have 1hour appointments to allow for a full holistic assessment. For open access clinics, it may not be possible to perform full assessment at the first appointment and a further booked appointment will be arranged. Appointment times for follow up visits will be flexible based upon the patients individual management need and the clinic philosophy. Clinic will be led by the community nursing team. The structure of the team will vary in each clinic depending on staff resource and competence. In adverse weather conditions and patients are unable to attend clinic, the patient will be contacted by phone and other arrangements made. The community tissue viability service will, if resources allow, offer specialist advice when requested. Visiting Nurses and Health Care Support Workers from neighbouring primary and community services will be encouraged to attend to improve and maintain their clinical skills. Principles of infection control will be applied at each clinic in between patient appointments and at each dressing change. A basic stock of dressing materials will be available at the clinic for use following assessment and review of the wound. A change in dressing regime will be communicated to the GP practice or if possible prescribed in the clinic by a nurse prescriber. Wound dressings chosen will take into account the Organisation wound dressing formulary. All patients attending the clinic will need to bring with them the prescribed dressing materials as provided by their GP Practice, unless the clinic is part of a non prescription dressing delivery service Patients who will need to be seen in between clinic appointments will be seen either in a neighbouring clinic or by arrangement with community teams depending on local agreement. It is expected that patients will attend clinic weekly to promote healing but those whose wounds do not show any evidence of progressing to healing after 12 weeks will be referred to an appropriate team such as TVN, Dermatology or Lymphoedema All patients will be provided with information regarding their leg ulceration and appropriate wound management needs. (Appendix 3) Patients will be given advice and information where appropriate regarding self care and management and prevention of further wound development. Patient experience will be captured using the NHS Wales National patient experience questionnaire at end of patient therapy. The questionnaire will be available in English and Welsh. Database No: Page 8 of 17 Version 0.3

HYWEL DDA UNIVERSITY HEALTH BOARD Each patient will be asked to manage their own leg ulcer care records for the duration of the treatment period: They will be asked to bring their records to each appointment relating to their wound/leg ulcer. The patient will also be advised that they will be asked to return the record at the conclusion of treatment/discharge from care as the documentation will need to form part of the patient's overall clinical record 7.2. Referrals 7.2.1. Referral to leg ulcer clinic/club Referral to the clinic is appropriate for patients who have: Non-responding wound present over six weeks to lower limb Non-responding wound present over six weeks plus: Mild oedema and minimal change in limb shape Minimal chronic skin changes Minimal oedema to the dorsum of the foot or toes Minimal oedema above the knee Non-resolving skin condition associated with venous disease 7.2.2. Exclusion criteria Patients with a foot ulcer resulting from Diabetes/ischaemia will not be assessed in this clinic as these patients will have access to open access diabetic foot clinics to be seen urgently. 7.2.3. Referral from the leg ulcer club/clinic Referrals to specialist services (Vascular team, Lymphoedema, Dermatology, Podiatry) will be made directly from the clinic, as required following referral criteria on the leg ulcer pathway referral form. A copy of the referral will be sent to the patients own General Practitioner. The referral form contained within the leg ulcer pathway will be completed and used. Identified concerns at the clinic requiring intervention such as antibiotic therapy will be communicated with the patients own General Practitioner. 7.3. Inter professional communication Communication is an integral part of care and will ensure consistency and minimise duplication of effort and resources Results of assessments will be recorded on the Health Boards Leg Ulcer Pathway documentation and wound management chart which the patient will be asked to bring with them to each clinic appointment. Staff in the leg ulcer/club will document their observations and interventions in the patient held record as will Practitioners seeing the patients in between Venous leg clinics/club appointments. Once treatment has finished and the patient is discharged from the clinic, the patient will be asked to return all the leg ulcer documentation to the clinic and this will then be stored by the relevant community teams. A letter summarising the assessment results, the treatment plan and a request for subsequent dressing materials will be sent to the GP. Collaborative working will be encouraged with potentials for complex and multiprofessional patient consultation. Where possible the clinic will be supported by a Volunteer who has undergone the appropriate training and governance procedures. Database No: Page 9 of 17 Version 0.3

7.4. Leg Club/Clinic Facilities Choice of clinic location will consider Patient transport- parking and access to public transport. Disabled wheelchair access to the clinic. Disabled and able bodied toilet facilities on the level floor. Secure storage space for essential specialist equipment and dressing materials. 7.5. Healed clubs/clinics As patients achieve healing outcome they will continue to be monitored in the leg clinic/club every six months If appropriate patients will be measured for appropriate compression hosiery and provided with a letter and prescribing details to the GP requesting a prescription for the same Compression hosiery will be chosen to reflect both the patients clinical need and lifestyle The compression hosiery recommended will be in adherence with the All Wales Lymphodema formulary (2015) 8. ROLES AND RESPONSIBILITIES 8.1. Director of Primary, Community and Mental Health Care The Director of Primary, Community and Mental Health Care has the accountability to ensure that there is a standardised service to meet the needs of patients with lower leg venous ulceration across the Organisation 8.2. County Directors County Directors have responsibility to ensure that there is an equitable, robust evidence based service in each County 8.3. The Community Head of Nursing The Community Head of Nursing has responsibility for professional leadership of the service 8.4. The Senior Sister/Team Leader The Senior Sister/Team Leader has responsibility to ensure that standards of care as recommended by this policy are met. They have the responsibility to identify and address staff training needs in relation to this. 8.5. The Clinic Lead Nurse Will monitor and triage all new referrals to the leg clinics/club ensuring that these are appropriate and timely. Will ensure patients attending leg clinic/club will have appropriate assessment and plan of care appropriate to their needs Will evaluate the care of patients attending the leg clinics/club Will refer onto the multidisciplinary team appropriately and in a timely manner Are responsible for monitoring quality through clinical audit, taking into account comments and concerns Database No: Page 10 of 17 Version 0.3

Ensure training relating to leg ulcer management is provided in a flexible and appropriate way to meet the learning needs of staff 8.6. The Community Tissue Viability Team Provide specialist advice and support when able and within the confines of their resources to practitioners working in the leg clinic/club. Will support in the development of local policies which incorporate National evidence based clinical practice guidelines and pathways of care to support the Organisation-wide implementation and evaluation. Will advise on a range of products/equipment and guidance on the use of such items relating to wound care and leg ulcer management and ensuring efficient usage of these products. 8.7. All healthcare professionals working in the leg clinics/clubs Are responsible and accountable for their own practice and will develop and maintain their clinical skills and competencies in the management of lower leg ulcers ensuring practice is current and evidence based. Are expected to work in partnership with the multidisciplinary team and other organisations (eg. other Health Boards, and statutory and voluntary organisations). Are responsible for supporting clinical audit activities Are responsible for delivering a high quality and cost effective service within the resources available. 8.8. Health care support workers Will support the Registered Nurse in the leg clinics/clubs welcoming the patient and ensuring stocks are complete, equipment is available and in good working order. Will undertake tasks allocated by the clinic team including removing patient dressings, soaking and cleaning and drying the leg and application of emollients, reporting all findings back to the Registered Nurse Will assist in data collection and any audits undertaken by the clinic team. 8.9. Volunteer The volunteer will have clear role description outlined (Appendix 2) The trained volunteer will be the initial point of contact for the patient and/or carer and will inform the health care support worker of patients arrival. The volunteer will facilitate the communal philosophy of the clinic by offering and preparing refreshments as necessary The volunteer will support the evaluation process by distributing the patient satisfaction questionnaires at the end of the 12 week evaluation period and /or when a patient no longer requires clinic appointments Database No: Page 11 of 17 Version 0.3

9. TRAINING Training and education of staff is a fundamental part of any strategy to improve the outcomes for patients with tissue viability needs. A multidisciplinary team perspective should be adopted where possible. Practitioners will need to acknowledge their own skills and limitations and initial training Registered nurses regularly attending to patients in the venous leg clinics/clubs will be encouraged to undertake further training specific to leg ulcer management/tissue viability as offered by higher education establishments (e.g.swansea University, tissue viability module SHG268/SHG3033). Registered Nurses regularly attending to patients in the venous leg clinics/clubs will be encouraged to undertake Agored Cymru assessor qualification The clinic will be a resource for registered and student nurses regarding updating of clinical skills in relation to leg ulcer assessment and the use of the Organisation s Leg Ulcer Pathway, arterial assessments (ABPI and TBPI measurements), compression short stretch and multilayer bandaging, measuring for compression hosiery and appropriate use of dressing materials as per the Organisation s Formulary of Dressing products. All staff working/rotating through the venous leg clinics /club will have to complete Agored Cymru competencies based on the work required on an annual basis. 9.1. Patient and carer information Information and education for patients and carers should be provided in clear and easy language without jargon, and in both visual and auditory form. Patient information will be available in both English and Welsh medium, (Appendix 3) alternative formats such as Easy Read or Youth friendly will be sought if required. Clear advice will be given for patients to ensure the healing potential of their wounds is maximised and that they have a responsibility to bring with them to clinic their dressing products as per GP prescription and all relevant nursing documentation to ensure at every visit. Interpretation and translation services may be provided during appointments as required. Information leaflets relating to leg ulceration will be available at the reception desk with the volunteer. 10. AUDIT AND EVALUATION The clinic will be evaluated quarterly and annually to determine Patient satisfaction. Incidence and presentation of wound types. Total number of patient contacts. Healing rates. Pain assessment Referral to other services. 11. IMPLEMENTATION This policy will be implemented through the usual distribution channels to appropriate areas and via the Organisation s Intranet site. Database No: Page 12 of 17 Version 0.3

12. FURTHER INFORMATION Hywel Dda University Health Board Leg Ulcer Pathway documentation Optimising Venous Leg Ulcer Services in a Changing NHS A UK Consensus http://www.sign.ac.uk/pdf/sign120.pdf Lymphoedema all Wales hosiery guidance HDUHB wound dressing formulary 13. REFERENCES Campbell,H.,Hotchkiss,R,Bradshaw,N and Porteous,M.(1998) Integrated Care Pathways. British Medical Journal 316, pp133-137 De Silva,T., Enoch,S.(2012)Surgical options in the management of intransigent leg ulcers. Wounds UK, 8:1.p36-46 Hampton, S. & Collins, F. (2004) Tissue Viability. WHURR, London King,J. (2012) Prevention of bilateral amputation in a non-concordant patient. BJN 21:12, S29- S32. Lindsay, E. (2008) The Leg Club Model:promoting the health of patienrs lower limbs through collaborative working. Wounds UK 4.2 49-60 Moffat, C. Martin, R. & Smithdale, R. (2007) Leg Ulcer Management. Blackwell Publishing, Oxford. Moloney,M.C., Grace, P.(2004) Understanding the underlying causes of chronic leg ulceration Journal of Wound Care. 13: 6, 215-218. Newton,H. (2010) Assessment of a venous leg ulcer. Wound Essentials Vol 5, 69-78 RCN Institute. (1998) Clinical Practice Guidelines: The Management of patients with venous leg ulcers. London: RCN Institute. Sarkarz,P.K.,Ballantyne,S. (2000)Management of leg ulcers. Postgrad Med J, 76:674-82 Scottish Intercollegiate Guidelines Network (2010) Management of chronic venous leg ulcers, A national clinical guideline 120. Edinburgh Simon,D., McCollum. (2004) Management of venous leg ulcers. Br Med J 328: 1358 Wasek, S. (Ed) (2013) Optimising Venous Leg Ulcer Services in a Changing NHS: a UK consensus Wounds UK, London White,R.,Ali,O.,Mackie,M.,Dix,F.,Young,T.,Clark,M.,Chadwick,P.,Hutchcox,S.,King,B.,Mangan, M., Bateman, S. and Oliver-Williams,R. (2011) Wounds uk. 7: 4 Database No: Page 13 of 17 Version 0.3

14. APPENDIX 1 LEG ULCER PATHWAY DOCUMENT Please see link below to the Leg Ulcer Pathway document. Leg Ulcer Pathway 2017.pdf Database No: Page 14 of 17 Version 0.3

15. APPENDIX 2 - VOLUNTEER ROLE DESCRIPTION Meet & Greet Volunteers Organisation Volunteering for Health Project Department Role Title Purpose of the Role Hywel Dda Health Board organisation was established on 1st October 2009 and provides healthcare services to a total population of around 372,320 throughout Carmarthenshire, Ceredigion and Pembrokeshire. It provides Acute, Primary, Community, Mental Health and Learning Disabilities services via General and Community Hospitals, Health Centres, GP's, Dentists, Pharmacists and Optometrists and other sites. The Hywel Dda Health Board was awarded a grant from the National Lottery to set up, develop and deliver a project known as Volunteering for Health. The project aims to develop volunteering services within the health community of West Wales in a variety of settings in Ceredigion, Pembrokeshire and Carmarthenshire. The project will improve the way current health services are delivered for the benefit of local citizens through action by local citizens. For volunteers it will provide an opportunity to give something back to the community, help them explore a career in health and social care, maintain and develop new skills, increase social interaction by meeting new people, enable volunteers to be recognised as a valuable resource and an integral part of service delivery within the NHS. Volunteering for HDUHB venous leg clinicss/clubs. Meet & Greet Volunteers The purpose of this role is to assist both patients and visitors with signposting, directing and taking them to the appropriate locations in accordance with their requests. Suggested activities Signposting visitors, relatives and patients to requested locations Ensuring all visitors sign in and out Inform members of staff of the arrival of their visitor/s where necessary Directing visitors to the relevant meeting/training room/clinic or waiting area. Recording arrival of patients for clinics taking place in the area Informing staff of arrival of patients Organising refreshments, tea, coffee or water, for meetings and patients etc. Supporting with handing out and collecting patient experience questionnaires Database No: Page 15 of 17 Version 0.3

Where When Duration To limit the activity to four hours per session Skills required An ability to communicate effectively. Have an awareness of visual, hearing and learning disability impairments. Have an approachable nature. A commitment to helping others. Welsh desirable but not essential Application CRB Support Supervision Training Expenses Uniform Minimum Age Other Contact details Initial discussion, application form and interview Criminal Record Bureau checks are carried out for this role. Two references will be required. The volunteer will have a clearly identified contact person in the Department who is responsible for the dayto-day support and guidance of the volunteer and who will be able to offer advice, support and feedback on a regular basis. Every six months, the volunteer and Volunteering Project Coordinator/Assistants will meet for a Joint Progress Review. Any additional to the corporate induction, volunteer specific information session and department orientation. Reimbursement of reasonable out of pocket expenses will be provided. Volunteers will be expected to wear clothes suitable to a clinic environment and an identification badge. 18 (although 16-18 will be considered depending on maturity) A trial period will allow you to try out your volunteer role and for staff to assess your suitability for the role. A review meeting should be held at the end of the trial period. Lee Oldale 07896917476 Email: lesley.oldale@wales.nhs.uk Database No: Page 16 of 17 Version 0.3

16. APPENDIX 3 PATIENT INFORMATION patient information leaflet welsh.pdf patient information leaflet english.pdf Database No: Page 17 of 17 Version 0.3