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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.

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.


Providing education to people who have developed or are at risk of developing a venous leg ulcer, along with their families and caregivers, can enable them to play an active role in self-examination and care. People involved in self-management can help prevent an initial ulcer, detect the signs and symptoms of an ulcer early on, monitor current ulcers to determine if they are getting worse, and prevent recurrent ulceration. Adherence to prevention and management strategies such as compression therapy, exercise, and leg elevation, can positively affect healing times and prevent recurrence. To support adherence, people with leg ulcers need to receive information about these interventions, including how to implement them. Educational materials should be offered in both oral and written formats and be tailored to a person’s language and education level where possible. The content of the education will vary depending on the needs of the patient, focusing on prevention and/or treatment.

For Patients

If you have a leg ulcer or are at risk for developing one, you and your family or caregiver should be taught about leg ulcers and who to contact for help.


For Clinicians

Offer people who have developed or are at risk of developing a venous leg ulcer, and their families and caregivers, education about leg ulcers and who to contact for early intervention when needed.


For Health Services

Ensure the availability of educational materials on venous leg ulcers for people who have developed or are at risk of developing leg ulcers, and their families and caregivers.

Process Indicator

Percentage of people who have developed or are at risk of developing a venous leg ulcer who, along with their families and caregivers, are offered education about venous leg ulcers and who to contact for early intervention when needed

  • Denominator: number of people who have developed a venous leg ulcer

  • Numerator: number of people in the denominator who, along with their families and caregivers, are offered education (such as printed materials, video presentations and in-person resource/instruction) about how to prevent foot complications, how to monitor for the signs and symptoms of foot complications, and who to contact for early intervention when needed.

  • Data source: local data collection


Structural Indicator

Availability of materials that provide education about venous leg ulcers for people who have developed or are at risk of developing a venous leg ulcer, along with their families

Risk factors

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 or 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

Education

This should be collaborative and interactive. The content will vary depending on the need of the patient, focusing on prevention and/or treatment, and may include the following topics:

  • Information about how venous leg ulcers develop and the symptoms a patient might experience
  • The importance of compression therapy, including wearing the stocking or bandage every day and the potential consequences of discontinuing compression therapy
  • Devices that may assist in applying and removing compression therapy
  • The importance of leg elevation and exercise (particularly to strengthen calf muscles, improve calf muscle pump function, ensure proper gait, and improve ankle range of motion), nutrition and weight management, skin care, and avoiding trauma
  • Seeking early intervention and who to contact at the signs of swelling, skin discolouration (including redness), or abnormal skin sensations
  • Managing comorbidities such as diabetes
  • How to access support groups that may provide education and psychosocial support

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