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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.

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.


All wounds contain bacterial flora, and wounds that are not healing may be infected, but leg ulcers without clinical evidence of infection should not be treated with antibiotics. Overuse and inappropriate use of antibiotics may contribute to the development of antibiotic-resistant bacteria. Deep/surrounding or systemic infection may be suspected when three or more of the following signs and symptoms are present: increased ulcer size; elevated temperature in the peri-wound; ability to probe to bone or the presence of exposed bone; new areas of tissue breakdown; presence of red tissue and swelling or edema; increased exudate; and foul odour. Pain is also a sign of deep infection.

For Patients

If you have a suspected deep/surrounding tissue or systemic infection, you should have an urgent assessment within 24 hours and treatment with antibiotics.


For Clinicians

Carry out an assessment within 24 hours and provide systemic antimicrobial treatment for people with a venous leg ulcer and suspected deep/surrounding tissue infection or systemic infection.


For Health Services

Ensure that systems, processes, and resources are in place to support clinicians in treating people with a venous leg ulcer with suspected deep/surrounding tissue infection or systemic infection.

Process Indicators

Percentage of people with a venous leg ulcer and a suspected deep/surrounding tissue infection who receive an assessment within 24 hours of initiation of care

  • Denominator: number of people with a venous leg ulcer and a suspected deep/surrounding tissue infection

  • Numerator: number of people in the denominator who receive an assessment within 24 hours of initiation of care

  • Data source: local data collection


Percentage of people with a venous leg ulcer and a suspected systemic infection who receive an assessment within 24 hours of initiation of care

  • Denominator: number of people with a venous leg ulcer and a suspected systemic infection
  • Numerator: number of people in the denominator who receive an assessment within 24 hours of initiation of care
  • Data source: local data collection

Percentage of people with a venous leg ulcer and a confirmed deep/surrounding tissue infection who receive systemic antimicrobial treatment

  • Denominator: number of people with a venous leg ulcer and a confirmed deep/surrounding tissue infection
  • Numerator: number of people in the denominator who receive systemic antimicrobial treatment
  • Data source: local data collection

Percentage of people with a venous leg ulcer and a confirmed systemic infection who receive systemic antimicrobial treatment

  • Denominator: number of people with a venous leg ulcer and a confirmed systemic infection
  • Numerator: number of people in the denominator who receive systemic antimicrobial treatment
  • Data source: local data collection
Deep/surrounding tissue infection

This is characterized as a deeper wound, such as an abscess, underlying osteomyelitis, septic arthritis, or fasciitis.


Systemic infection

This is characterized as local infection with signs of systemic inflammatory response syndrome.

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