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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.

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.


An individualized care plan guides effective, integrated coordination and delivery of care. Developing treatment plans and goals should be a collaborative process involving the health care professional(s) and the person receiving care. Regular review of the care plan also provides an opportunity to revisit goals, review progress, and make adjustments based on the changing needs and preferences of the person receiving care.

For Patients

Your health care professional should work with you to develop a care plan that reflects your needs, concerns, and preferences. A care plan is a written document that you have agreed on with your health care professional. It describes your goals for your care, the care you will receive, and who will provide it.


For Clinicians

Work with people who have a venous leg ulcer to create a mutually agreed-upon individualized care plan that identifies patient-centred concerns and is reviewed and updated regularly.


For Health Services

Ensure that systems, processes, and resources are in place to support clinicians in developing individualized care plans for people with a venous leg ulcer. This may also include tools such as standardized care plan templates.

Process Indicators

Percentage of people with a venous leg ulcer who have a mutually agreed-upon individualized care plan that identifies patient-centred concerns

  • Denominator: number of people with a venous leg ulcer

  • Numerator: number of people in the denominator who have a mutually agreed-upon individualized care plan that identifies patient-centred concerns

  • Data source: local data collection


Percentage of people with a venous leg ulcer who have had their individualized care plan reviewed and updated regularly

  • Denominator: number of people with a venous leg ulcer

  • Numerator: number of people in the denominator who have had their individualized care plan reviewed and updated regularly (frequency may range from daily to every 3 months)

  • Data source: local data collection

Individualized care plan

This includes the following components, at a minimum:

  • Results of the comprehensive assessment (see Quality Statement 3), including identified risk factors and the dimensions, characteristics, and healing trajectory of the ulcer (these should be reassessed on a regular basis)
  • Education (see Quality Statement 2)
  • Mutually agreed-upon goals and individual concerns and preferences
  • Factors that may affect wound healing and patient-centred concerns, such as pain management, optimizing activities of daily living, and psychosocial needs and supports
  • A plan for local wound care based on the healing potential of the wound, which may include:
    • Compression therapy
    • Debridement
    • Infection management
    • Dressings and moisture balance
  • Exercise (particularly to strengthen calf muscles, improve calf muscle pump function, ensure proper gait, and improve ankle range of motion)
  • Strategies for preventing recurrence

Reviewed and updated regularly

Frequency may range from daily (during dressing changes and based on regular wound assessments) to every 1 to 3 months (for a full care plan review) and is based on the characteristics of the wound, the acuity of the problem, and whether or not there are significant changes. Reviewing the care plan may require a partial reassessment (repeating aspects of the comprehensive assessment) or a full reassessment, including revisiting the goals of care.

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