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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.

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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.


Referral to health care professionals who offer specialized services is important when ulcers are atypical or are not healing with appropriate local wound care. Referral to a specialist may be required in the following circumstances: “diagnostic uncertainty; atypical ulcer characteristics or location; suspicion of malignancy; treatment of underlying conditions, including diabetes, rheumatoid arthritis, and vasculitis; suspected presence of peripheral arterial disease; ankle-brachial pressure index greater than 1.2; contact dermatitis; ulcers that have not healed within three months; recurring ulceration; healed ulcers with a view to venous surgery; antibiotic-resistant infected ulcers; ulcers causing uncontrolled pain”; as well as cellulitis, venous thromboembolism, and variceal bleeds.

For Patients

If your leg ulcer is unusual or not healing, you should be referred to a specialist for further assessment and appropriate treatment.


For Clinicians

Refer people with a venous leg ulcer that is atypical, or that fails to heal and progress despite optimal care, to a specialist for further assessment and appropriate treatment.


For Health Services

Ensure that systems, procedures (protocols), and resources are in place for referral to a specialist for people with a venous leg ulcer that is atypical, or that fails to heal and progress despite optimal care.

Process Indicator

Percentage of people with a venous leg ulcer that is atypical, or that fails to heal and progress within 3 months despite optimal care, who are seen by a specialist

  • Denominator: number of people with a venous leg ulcer that is atypical, or that fails to heal within 3 months and progress despite optimal care

  • Numerator: number of people in the denominator who are seen by a specialist

  • Data source: local data collection

Atypical ulcer

Unusual characteristics or location. Typical characteristics of a venous leg ulcer include:

  • Location on the lower leg

  • Irregular edges

  • Wound bed that is shallow, ruddy red, with yellow slough and granulation tissue

  • Mild, moderate, or heavy amount of exudate

  • Surrounding (peri-wound) skin is macerated, crusty, scaling, or hyperpigmented

  • Odour and bleeding may or may not be present


Ulcer that fails to heal and progress

A healable ulcer that has not reduced in size by 25% in 1 month or healed within 3 months despite optimal care.


Specialist

Health care professional with specialized training, experience, and expertise in wound care.

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