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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.

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.


A comprehensive assessment helps identify causative and contributing factors, supports accurate diagnosis, and informs treatment and management. The results of the assessment help to determine the healability of the ulcer (ulcers may be classified as healable, maintenance, or non-healable) and informs a corresponding approach to optimal wound care and management. Healable wounds have adequate blood supply and can be healed if the underlying cause is addressed and treated. Maintenance wounds have healing potential, but barriers are present that may prevent healing (such as lack of access to appropriate treatments and poor adherence to treatment). Non-healable wounds are not likely to heal because of non-treatable causes or illnesses. Comprehensive assessment also provides an opportunity to determine risk factors for recurrence, which is important given the high rate of recurrence of venous leg ulcers. Reassessment should be carried out at regular intervals to support ongoing management and monitoring of the healing process (optimal healing is characterized by a 25% reduction in size after 1 month).

For Patients

If you have a leg ulcer, you should have a full assessment. Your health care team will want to learn more about your health history, concerns, and preferences. They should also examine your legs and feet, including any wounds you have. They will use this information to develop a care plan with you.


For Clinicians

Carry out a comprehensive assessment for people with a venous leg ulcer to determine the healing potential of the wound. The results should inform their individualized care plan.


For Health Services

Ensure that tools, systems, processes, and resources are in place to help clinicians assess people with a venous leg ulcer. This includes providing the time required for a full assessment and ensuring access to assessment tools.

Process Indicators

Percentage of people with a venous leg ulcer who have a comprehensive assessment at first presentation, conducted by a health care professional trained in leg ulcer assessment and treatment, to determine the healing potential of the wound

  • Denominator: number of people with a venous leg ulcer

  • Numerator: number of people in the denominator who have a comprehensive assessment at first presentation, conducted by a health care professional trained in leg ulcer assessment and treatment, to determine the healing potential of the wound

  • Data source: local data collection


Percentage of people with a venous leg ulcer who have a comprehensive assessment at each transition, conducted by a health care professional trained in leg ulcer assessment and treatment, to determine the healing potential of the wound

  • Denominator: number of people with a venous leg ulcer

  • Numerator: number of people in the denominator who have a comprehensive assessment at each transition, conducted by a health care professional trained in leg ulcer assessment and treatment, to determine the healing potential of the wound

  • Data source: local data collection


Percentage of people with a venous leg ulcer who have a comprehensive assessment at first presentation that informs their individualized care plan

  • Denominator: number of people with a venous leg ulcer

  • Numerator: number of people in the denominator who have a comprehensive assessment at first presentation that informs their individualized care plan

  • Data source: local data collection

Percentage of people with a venous leg ulcer who have a comprehensive assessment at each transition that informs their individualized care plan

  • Denominator: number of people with a venous leg ulcer

  • Numerator: number of people in the denominator who have a comprehensive assessment at each transition that informs their individualized care plan

  • Data source: local data collection

Comprehensive assessment

This includes the following components, at a minimum:

  • A comprehensive health history to identify risk factors (see definitions under Quality Statement 2)

  • Pain history and characteristics

  • Medication history

  • Nutritional assessment

  • Psychosocial assessment

  • Screening for peripheral arterial disease (ankle-brachial pressure index or toe-brachial pressure testing if ankle-brachial pressure index is not possible)

  • Physical examination of the limb(s):

    • Functional ability, including ankle range of motion and calf muscle pump function

    • Skin perfusion

    • Skin changes (including colour and temperature)

    • Pedal pulses

    • Swelling of the calf, thigh, and ankle

    • Signs and symptoms of infection

  • Wound assessment:

    • Length, width, depth, and location

    • Edges and wound bed

    • Exudate, odour, pain, bleeding, and peri-wound condition

    • Signs and symptoms of infection

  • Factors that may affect wound healing, such as comorbid conditions, limited adherence to prevention or treatment interventions (such as compression therapy), and medications

  • Individual concerns and preferences, and activities of daily living

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