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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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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.


People who have developed or are at risk of developing venous leg ulcers benefit from individualized care by health care professionals who have specific, comprehensive training and education in the appropriate assessment and management of these types of wounds. Training and education materials or programs are additional to entry-level programs and should be tailored to providers' roles and responsibilities.

For Patients

You should receive care from a team of health care professionals who have been trained to care for people who have a venous leg ulcer or are at risk for one.


For Clinicians

Ensure that you have the training and education required to effectively provide care (including assessments and treatments) for people who have developed or are at risk of developing a venous leg ulcer, in accordance with your professional role.


For Health Services

Ensure that health care providers caring for people who have developed or are at risk of developing a venous leg ulcer have training and education in how to carry out comprehensive assessments and provide appropriate treatment, including compression therapy and local wound care.

Structural Indicator

Local availability of providers trained in the assessment and management of venous leg ulcers

Risk of developing a venous leg ulcer

People are at a higher risk of developing a venous leg ulcer if they have signs and symptoms of venous disease and:

  • Have had a previous leg ulcer

  • Have a family history of venous disease, leg ulcers, or varicose veins

  • Have a history of thrombophilia, venous thromboembolism, or phlebitis

  • Have had trauma, injury, or major surgery to the leg

  • Have had multiple pregnancies

  • Are obese

  • Have a sedentary occupation and lifestyle (people who stand or sit for long periods of time throughout the day)

  • Have impaired/limited calf muscle pump function and restricted ankle range of motion


Provider training and education

These should include the following skills and information, at a minimum:

  • Ankle-brachial pressure index testing (Quality Statement 1)

  • Techniques for providing effective patient education (Quality Statement 2)

  • Comprehensive assessment (Quality Statement 3) and individualized care planning (Quality Statement 4)

  • Compression therapy (proper application and monitoring) (Quality Statement 5)

  • Treatment, including local wound care (Quality Statements 6, 7, 8, 9)

  • Criteria for specialist referral (Quality Statement 11)

  • Primary prevention and prevention of recurrence

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