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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.

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.


The purpose of debridement is to remove nonviable, dead (slough and/or necrotic) tissue, callus, and foreign matter (debris) from the wound to reduce infection and promote healing. There are many methods of debridement, but the most common are sharp/surgical, autolytic, and mechanical. The choice of method and frequency of debridement should be based on individual tolerance, preference, and goals of care; the presence of infection; the amount of exudate; the amount and type of dead tissue; and the skill and training of the health care professional. Sharp debridement requires specialized knowledge, education, and skills.

For Patients

To help your wound heal, you should have dead skin, callus, and debris removed (this is called debridement) if your health care professional determines that it is necessary and appropriate.


For Clinicians

Debride wounds for people with a venous leg ulcer using an appropriate method of debridement if it is determined as necessary in their assessment, and if it is not contraindicated. Sharp/surgical debridement should be considered first, unless it is contraindicated.


For Health Services

Ensure that health care professionals across settings who care for people with venous leg ulcers are trained in appropriate methods of wound debridement. This includes providing access to training programs and materials.

Process Indicators

Percentage of people with a venous leg ulcer who have their wound appropriately debrided by a trained health care professional if it is determined as necessary in their assessment

  • Denominator: number of people with a venous leg ulcer and wound debridement determined as necessary in their assessment

  • Numerator: number of people in the denominator who have their wound appropriately debrided (using sharp/surgical, mechanical, or autolytic methods) by a trained health care professional

  • Data source: local data collection

  • Potential stratification: patient type

Contraindication

Inadequate vascular supply.


Appropriate method of debridement

Sharp/surgical debridement should be considered first for the removal of slough and dead tissue, unless it is contraindicated (for example, limited vascular supply), and if it is in alignment with the individualized care plan and mutually agreed-upon goals of care. Sharp/surgical debridement may be active/aggressive (extensive and aggressive removal of tissue) or conservative (removal of loose, dead tissue without pain or bleeding). Other appropriate methods include mechanical and autolytic debridement. Pain should be managed during debridement.


Trained health care professional

The health care professional has training specific to the method of debridement being used.

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