References

Adderley UJ, Thompson C. Confidence and clinical judgement in community nurses managing venous leg ulceration–A judgement analysis. J Tissue Viability. 2017; 26:(4)271-276 https://doi.org/10.1016/j.jtv.2017.07.003

Ashby RL, Gabe R, Ali S Clinical and cost-effectiveness of compression hosiery versus compression bandages in treatment of venous leg ulcers (Venous Leg Ulcer Study IV, VenUS IV): a randomised controlled trial. Lancet. 2014; 383:(9920)871-879 https://doi.org/10.1016/S0140-6736(13)62368-5

Atkin L, Critchley A. The leg ulceration pathway: impact of implementation. Wounds UK. 2017; 13:(4)107-112

Atkin L, Tickle J. A new pathway for lower limb ulceration. Wounds UK. 2016; 12:(2)32-36

Bianchi J. The CHROSS Checker: a tool kit to detect early skin changes associated with venous and lymphovenous disease. J Community Nurs. 2013; 27:(4)43-49

British Lymphology Society. Position paper for ankle brachial pressure index (ABPI). Informing decision making prior to the application of compression therapy. 2018. https://tinyurl.com/y5btfkkl (accessed 4 July 2019)

Casey G. Causes and management of leg and foot ulcers. Nursing Standard. 2004; 18:(45)57-64 https://doi.org/10.7748/ns2004.07.18.45.57.c3653

Wounds research for patient benefit: a 5-year programme of research. 2016. https://tinyurl.com/y6y5ewcj (accessed 4 July 2019)

Franks P, Barker J, Collier M Management of patients with venous leg ulcer: challenges and current best practice. J Wound Care. 2016; 25:1-67 https://doi.org/10.12968/jowc.2016.25.Sup6.S1

Gohel MS, Heatley F, Liu X A randomized trial of early endovenous ablation in venous ulceration. N Engl J Med. 2018; 378:(22)2105-2114 https://doi.org/10.1056/NEJMoa1801214

Gohel MS, Poskitt KR. Chronic ulceration of the leg. Surgery (Oxford). 2010; 28:273-276 https://doi.org/10.1016/j.mpsur.2010.02.005

Grol R, Buchan H. Clinical guidelines: what can we do to increase their use?. Med J Aust. 2006; 185:(6)301-302

Guest JF, Ayoub N, McIlwraith T Health economic burden that different wound types impose on the UK's National Health Service. Int Wound J. 2017; 14:(2)322-330 https://doi.org/10.1111/iwj.12603

Health economic burden that wounds impose on the National Health Service in the UK. 2015. https://10.1136/bmjopen-2015-009283

Hensen P, Ma HL, Luger TA, Roeder N, Steinhoff M. Pathway management in ambulatory wound care: defining local standards for quality improvement and interprofessional care. Int Wound J. 2005; 2:(2)104-111 https://doi.org/10.1111/j.1742-4801.2005.00098.x

Herber OR, Schnepp W, Rieger MA. A systematic review on the impact of leg ulceration on patients' quality of life. Health Qual Life Outcomes. 2007; 5 https://doi.org/10.1186/1477-7525-5-44

Legs Matter. 2018. https://tinyurl.com/y9kbw2wy (accessed 4 July 2019)

Venous leg ulcers. 2016. https://tinyurl.com/y3dca757 (accessed 4 July 2019)

O'Meara S, Cullum N, Nelson EA, Dumville JC. Compression for venous leg ulcers. Cochrane Database Syst Rev. 2012; 11 https://doi.org/10.1002/14651858.CD000265.pub3

Staines K. Safe compression and accurate ABPI–overcoming barriers. Wounds UK. 2018; 14:(1)64-67

The AHSN Network. National wound care strategy programme. 2018. https://tinyurl.com/y4djuenz (accessed 4 July 2019)

Wounds UK. Best Practice Statement: Holistic management of venous leg ulceration. 2016. https://tinyurl.com/yyeaeqyn (accessed 4 July 2019)

Updated leg ulcer pathway: improving healing times and reducing costs

14 November 2019
Case Report
02 November 2019
Volume 28 · Issue 20

Abstract

Regardless of the amount of literature and evidence on leg ulcer management, there are still significant variations in treatment. Implementing a standardised leg ulcer pathway to ensure patients are appropriately and timely assessed could help reduce nursing time and overall costs, while improving healing outcomes and patients' quality of life. Such a pathway was introduced in Lincolnshire and Leicestershire, UK, to treat venous leg ulcers (VLUs). The results showed improved healing times, reduced costs and fewer nurse visits, among other findings.

Leg ulceration is a common cause of suffering for patients. Its treatment places a significant burden on the NHS, especially within community nursing services (Atkin and Critchley, 2017). Despite the abundance of literature and evidence available, there are significant variations in leg ulcer management in clinical practice. Such variations have been highlighted by NHS England's ‘Betty's Story’ under the ‘Leading Change, Adding Value’ framework, which provided detailed evidence on unnecessary spend, multiple visits to healthcare providers, elongated healing times, and impact on patients' quality of life. National initiatives, such as the Legs Matter campaign (Legs Matter, 2018) and National Wound Care Strategy Programme (The AHSN Network, 2018), set aims to increase overall awareness and improve patient care. It is vital that health services move towards the elimination of unwanted variations on leg ulcer management, ensuring that all patients are appropriately and timely assessed, that diagnosis of underlying pathophysiology is clear, and that evidence-based interventions form the heart of treatment plans.

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content

Register
Or continue by

Signing in with your registered email address

Leg ulceration
Burden of wound care
Compression
Venous ulceration
Cost-effective care