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Evidence to Improve Care

Venous Leg Ulcers

Care for Patients in All Settings

Click below to see a list of brief quality statements and scroll down for more information.​​


Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence. ​

See below for the quality statements and click for more detail.​


Quality Statement 1: Screening for Peripheral Arterial Disease
People with a suspected venous leg ulcer are screened for peripheral arterial disease using the ankle-brachial pressure index (ABPI) or an alternative such as the toe-brachial pressure index (TBPI) if ABPI is not possible. Screening is conducted by a trained health care professional during the initial comprehensive assessment and at regular intervals (at least every 12 months) thereafter.


Quality Statement 2: Patient Education and Self-Management
People who have developed or are at risk of developing a venous leg ulcer, and their families or caregivers, are offered education about venous leg ulcers and who to contact for early intervention when needed.


Quality Statement 3: Comprehensive Assessment
People with a venous leg ulcer undergo a comprehensive assessment conducted by a health care professional trained in leg ulcer assessment and treatment, to determine the healing potential of the wound. This assessment informs the individualized care plan.


Quality Statement 4: Individualized Care Plan
People with a venous leg ulcer have a mutually agreed-upon individualized care plan that identifies patient-centred concerns and is reviewed and updated regularly.


Quality Statement 5: Compression Therapy
People who have developed or are at risk of developing a venous leg ulcer are offered compression therapy that is applied by a trained individual based on the results of the assessment and patient-centred goals of care.


Quality Statement 6: Wound Debridement
People with a venous leg ulcer have their wound debrided if it is determined as necessary in their assessment, and if it is not contraindicated. Debridement is carried out by a trained health care professional using an appropriate method.


Quality Statement 7: Local Infection Management
People with a venous leg ulcer and a local infection receive appropriate treatment, including antimicrobial and non-antimicrobial interventions.


Quality Statement 8: Deep/Surrounding Tissue Infection or Systemic Infection Management
People with a venous leg ulcer and a suspected deep/surrounding tissue infection or systemic infection receive urgent assessment (within 24 hours of initiation of care) and systemic antimicrobial treatment.


Quality Statement 9: Wound Moisture Management
People with a venous leg ulcer receive wound care that maintains the appropriate moisture balance or moisture reduction in the wound bed.


Quality Statement 10: Treatment with Pentoxifylline
People with large, slow-healing venous leg ulcers are assessed for appropriateness for pentoxifylline in combination with compression therapy.


Quality Statement 11: Referral to Specialist
People with a venous leg ulcer that is atypical, or that fails to heal and progress within 3 months despite optimal care, are referred to a specialist.


Quality Statement 12: Health Care Provider Training and Education
People who have developed or are at risk of developing a venous leg ulcer receive care from health care providers with training and education in the assessment and treatment of venous leg ulcers.


Quality Statement 13: Transitions in Care
People with a venous leg ulcer who transition between care settings have a team or provider who is accountable for coordination and communication to ensure the effective transfer of information related to their care.

1

Screening for Peripheral Arterial Disease

People with a suspected venous leg ulcer are screened for peripheral arterial disease using the ankle-brachial pressure index (ABPI) or an alternative such as the toe-brachial pressure index (TBPI) if ABPI is not possible. Screening is conducted by a trained health care professional during the initial comprehensive assessment and at regular intervals (at least every 12 months) thereafter.


Prior to treatment, it is crucial to determine the cause and type of leg ulcer, because arterial and venous leg ulcers require different approaches to treatment and management. For example, compression therapy is an appropriate treatment for venous ulcers (see Quality Statement 5) but may not be appropriate or safe for arterial leg ulcers, depending on the severity of the arterial disease. Approximately 15% to 25% of people with venous leg ulcers will also have peripheral arterial disease. Measurement of ABPI using Doppler ultrasound is the most common way to identify the presence of arterial disease; however, the test should be conducted by trained health care providers, and the results may be unreliable if people have calcification or diabetes.

For Patients

If your health care professional thinks you might have a leg ulcer, you should have a test for peripheral arterial disease at least once a year. The results will determine what type of treatment you should have, such as compression therapy.


For Clinicians

Conduct ABPI or alternative testing to screen for the presence of peripheral arterial disease if you suspect that someone has a venous leg ulcer. This should be done during the initial comprehensive assessment and at appropriate intervals thereafter to determine and ensure the appropriate treatment.


For Health Services

Ensure that tools, systems, processes, and resources are in place to support clinicians in conducting ABPI or alternative testing to screen for the presence of peripheral arterial disease when they suspect that someone has a venous leg ulcer. This includes providing access to training programs and materials.

Process Indicators

Percentage of people with a suspected venous leg ulcer who are screened for peripheral arterial disease using the ABPI or an alternative such as the TBPI during their initial comprehensive assessment

  • Denominator: number of people with a suspected venous leg ulcer

  • Numerator: number of people in the denominator who are screened for peripheral arterial disease using the ABPI or an alternative such as the TBPI during their initial comprehensive assessment

  • Data source: local data collection


Percentage of people with a non-healing venous leg ulcer who have been reassessed for peripheral arterial disease using the ABPI or an alternative such as the TBPI in the previous 12 months or more often

  • Denominator: number of people with a non-healing venous leg ulcer for more than 12 months

  • Numerator: number of people in the denominator who have been reassessed for peripheral arterial disease using the ABPI or an alternative such as the TBPI in the previous 12 months or more often (if there is a change in the signs and symptoms of peripheral arterial disease)

  • Data source: local data collection

Ankle-brachial pressure index

A vascular test that can be used to determine if there is sufficient arterial blood flow in the leg.

  • ABPI of less than or equal to 0.9 at rest is a cut-off point for peripheral arterial disease

  • ABPI of less than or equal to 0.5 is usually an indication of critical limb ischemia

  • ABPI greater than 1.3 (range of 1.2 to 1.4) suggests possible arterial calcification


Alternative testing

This includes TBPI if ABPI is not accurate or feasible (i.e., cannot be tolerated owing to pain or the location of the ulcer).


Regular intervals

Every 12 months, or more often if there is a change in the signs and symptoms of peripheral arterial disease.

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