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 Statements in Brief

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.

Resources Quality Statements Advisory Committee About

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.

Background

Wound care that maintains moisture balance to promote healing includes cleansing of the wound (tap water is usually sufficient) and selection of a dressing that promotes a moist wound healing environment (for healable ulcers) or moisture reduction (for maintenance ulcers and non-healable ulcers). Cleansing the wound promotes healing by supporting improved wound assessment, increased comfort when adherent dressings are removed, and the potential for rehydration of the wound. There are many options for wound dressings. Selection of these products should be based on clinical assessment of the wound and phase of healing; patient preference; pain management considerations; and ability to maintain a moist wound bed, control exudate, and avoid breakdown of the surrounding skin.

What This Quality Statement Means

For Patients

Your health care team will determine whether your wound can heal or not. You should have a dressing that keeps the wound moist if it can heal, or dry if it cannot heal.

For Clinicians

For people with a venous leg ulcer, provide wound care that maintains the appropriate moisture balance or moisture reduction in the wound bed. A moist wound environment is appropriate for healable ulcers. Moisture reduction is appropriate for maintenance and non-healable ulcers.

For Health Services

Ensure that systems, procedures (protocols), and resources are in place to support clinicians in providing wound care that maintains the appropriate moisture balance or moisture reduction in the wound bed.

Quality Indicators

Process Indicators

Percentage of people with a healable venous leg ulcer who receive wound care that maintains the appropriate moisture balance in the wound bed and a moist wound environment

Denominator: number of people with a healable venous leg ulcer
Numerator: number of people in the denominator who receive wound care that maintains the appropriate moisture balance in the wound bed and a moist wound environment
Data source: local data collection

Percentage of people with a maintenance or non-healable venous leg ulcer who receive wound care that maintains the appropriate moisture reduction in the wound bed

Denominator: number of people with a maintenance or non-healable venous leg ulcer
Numerator: number of people in the denominator who receive wound care that maintains the appropriate moisture reduction in the wound bed
Data source: local data collection

Definitions Used Within This Quality Statement

Moisture management

This is specific to the type of wound:

Moisture balance and a moist wound environment for healable ulcers (ulcers that have adequate blood supply and can be healed if the underlying cause is addressed and treated). Note: increased moisture is a sign of infection, which should be treated.
Moisture reduction for maintenance ulcers (ulcers that have healing potential, but barriers are present that may prevent healing, such as lack of access to appropriate treatment and poor adherence to treatment) or non-healable ulcers (ulcers that are not likely to heal because of non-treatable causes or illnesses).

Evidence to Improve Care