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Background


From April 2013 until March 2014, venous leg ulcer care in Waterloo Wellington region cost the Community Care Access Centre over half a million dollars. A significant number of nursing visits were required for over 300 patients with venous leg ulcers at an average cost per client of $1631. The average length of stay requiring community wound care for patients with venous leg ulcers in Waterloo Wellington was 104 days1.

Venous leg ulcers are often chronic wounds that are usually the result of compromised circulation. Patients with venous ulcers require vascular assessments to determine treatment and their ability to heal. These patients require long term compression treatment to treat ulcers and to prevent reoccurrence2.

As the population ages and increases, the number of patients with venous ulcers, the strain on community services and the inherent cost of care are expected to increase exponentially. It is imperative for evidence-based best practices be followed in order to improve clinical outcomes and improve access to wound care services, thereby allowing the utilization of health care funds in the most appropriate manner3.

Best Practices for Assessment, Prevention, and Treatment of Venous Leg Ulcers

In 2001, The Canadian Association of Wound Care (CAWC) developed best practice recommendations for the prevention and treatment of venous leg ulcers for clinical practice. The RNAO produced a nursing best practice guideline for the Assessment and Management of Venous Leg Ulcers in 20044. In 2006, Burrows et al did a review of existing literature to identify any new changes of practice. They reviewed both the CAWC and RNAO guidelines. Combining both sets of guidelines allowed them to produce a paper that is evidence-based and inter-professional5.

All clinicians are expected to use best practices to assess, prevent, and treat venous ulcers to improve patient outcomes. The framework used in this guideline was applied from the Registered Nurses Association of Ontario (RNAO) “Clinical Practice Guidelines of Assessment and Management of Venous Ulcers (2004)6 and its supplement (2007)7. The RNAO Clinical Best Practice Guidelines “Strategies to Support Self-Management in Chronic Conditions: Collaboration with Clients” (2010)8 was also used for self-management section. A complete list of references used can be found in the appendices.

Wound Bed Preparation Paradigm

The wound bed preparation (WBP)9 paradigm is used to assess, diagnosis, and treat wounds while considering patient concerns. It links evidence-based literature, expert opinion, and clinical experiences of respected wound care specialists. The framework is beneficial because the components are interrelated and can be re-evaluated if the wound deviates from the care plan. Furthermore, the interprofessional team is able to collaborate together through shared discussion to classify a healable, maintenance, and non-healable wound.


Figure 1 - Wound Bed Preparation Paradigm10

Wound Bed Preparation Paradigm

Address Patient-Centred Concerns
  1. Waterloo Wellington Community Care Access Centre. Current-State Assessment. February 2014
  2. Krasner DL, Rodeheaver GT, Sibbald RG. Chronic Wound Care: A Clinical Source Book for Healthcare Professionals. 4th Ed. Malvern, PA. HMP Communications; 2007
  3. Krasner DL, Rodeheaver GT, Sibbald RG. Chronic Wound Care: A Clinical Source Book for Healthcare Professionals. 4th Ed. Malvern, PA. HMP Communications; 2007
  4. Registered Nurses Association of Ontario. Nursing Best Practice Guideline: Assessment and Management of Venous Leg Ulcers. March 2004
  5. Burrows C, Miller R, et al. Best Practice Recommendations for the Prevention and Treatment of Venous Leg Ulcers: Update 2006. Wound Care Canada. 2006;4(1)
  6. Registered Nurses Association of Ontario. Nursing Best Practice Guideline: Assessment and Management of Venous Leg Ulcers. March 2004
  7. Registered Nurses Association of Ontario. Nursing Best Practice Guideline Supplement: Assessment and Management of Venous Leg Ulcers. March 2007
  8. Registered Nurses Association of Ontario. Nursing Best Practice Guideline: Strategies to Support Self-Management in Chronic Conditions: Collaboration with Clients. September 2010
  9. Burrows C, Miller R, et al. Best Practice Recommendations for the Prevention and Treatment of Venous Leg Ulcers: Update 2006. Wound Care Canada. 2006;4(1)
  10. Sibbald RG, Orstead HL, Coutts PM, Keats DH. Best Practice Recommendations for Preparing the Wound Bed: Update 2006. Wound Care Canada. Volume 4 Number 1. 2006

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