Venous leg ulcer care: how evidence-based is nursing practice?

Area of Science:

• Vascular Medicine
• Wound Care
• Health Services Research

Background:

• Venous leg ulcers require evidence-based care for optimal outcomes.
• Community nursing agencies provide care for a significant number of patients with leg ulcers.
• Understanding adherence to best practices in community leg ulcer care is crucial for improving patient management.

Purpose of the Study:

• To evaluate the congruence of community-provided leg ulcer care with established best practices for venous leg ulcers.
• To identify organizational and clinical factors influencing the delivery of best practice in venous leg ulcer management.

Main Methods:

• A practice variation study was conducted using an audit of nursing agency client records.
• The study population comprised 66 home care patients with venous leg ulcers in Ontario.
• An audit tool, based on international guidelines, assessed care provision and influencing factors.

Main Results:

• Etiology was identified in only half of records; Ankle Brachial Pressure Index (ABPI) was documented pre-compression in less than half.
• Regular ulcer measurement occurred in 11% of clients, while compression was used in two-thirds.
• Significant gaps existed in pain assessment (15%), pain management (17%), and client education (3%).

Conclusions:

• Gaps in leg ulcer care necessitate a standardized approach, including comprehensive assessment, ABPI screening, and appropriate compression therapy.
• Reorganization of services is required, enhancing community nurses' roles in assessment and management.
• Organizational and clinical factors impacting best practice delivery must be identified and addressed.