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Driving Systemic Change: Integrating Heart Failure Recognition into the 2025 Chronic Oedema Wet Leg Pathway through District Nursing Education Project

 


Swansea Bay University Health Board


Introduction:

This project aimed to improve early recognition of heart failure (HF) in patients with chronic oedema on the 'wet leg' pathway by educating district nurses (DNs) on HF signs, symptoms, and NTproBNP testing. The initiative supports the NHS Duty of Quality by enhancing clinical effectiveness, promoting safety, and enabling workforce development, aligning with the British Society for Heart Failure’s 25in25 national strategy to reduce HF mortality.


Methods:

Using the 6Cs stakeholder model, co-production and tools (Fishbone diagrams, 5 Whys, Pareto analysis), the project identified knowledge gaps and practical barriers. Targeted education sessions were developed and tailored for Bands 2–7 staff. Two PDSA cycles tested and adapted training content, with one version for registered nurses and another for healthcare support workers (HCSWs). Surveys and audits measured changes in knowledge, confidence, and clinical practice.


Outcomes:

  • 78% increase in recognition of HF symptoms
  • NTproBNP awareness rose from 19% to 90% post education
  • 24% rise in NTproBNP test requests
  • 50% of tests returned positive; 38% required urgent referral
  • 100% positive staff feedback and increased confidence in escalating care
  • Findings are informing changes to the All-Wales Wet Leg Pathway

Learnings:

Effective change stems from co-production, tailored education, and strong stakeholder engagement. Challenges included time constraints, staff turnover, and variation in engagement. Success factors included continuing professional development recognition, real-time feedback, and structured evaluation. Education proved a powerful tool for improving patient care and interdisciplinary working.


What Next?

The programme will be rolled out across all DN clusters in Swansea Bay UHB. Ongoing data monitoring and pathway refinement continue in collaboration with the National Lymphoedema Service. The project has gained national and international interest, with upcoming presentations and a grant application to scale the work across Wales.

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Get in touch. For contact details of our programme leads, see our Meet the Team page.

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