The Management of Patients with Venous Leg Ulcers


The national guidelines generally define a leg ulcer as a break in the skin of the lower leg, which takes more than 4-6 weeks to heal (Royal College of Nursing [RCN] 1998.)

My objective is to discuss common outcome measures of the effectiveness of nurse led community leg ulcer clinic as a model of care for patients with chronic venous leg ulcers. This will be in terms of healing rates; costs and health related quality of life. The comparator will be considered the home-based delivery of care as this previously represented the common practice in dealing with venous leg ulcers.

There is widespread variation in practice, and evidence of unnecessary suffering and costs due to inadequate management of venous leg ulcers in the community, (NHS Centre for Reviews and Dissemination, 1997).

Patient non-compliance has been found to influence the healing rates of patients with leg ulcers. Social isolation is frequently cited as a negative aspect of chronic leg ulceration. It has been found that some patients do not want their ulcer to heal because this would reduce the amount of social contact that they have become used to as a result of their wound (Brown 2003).

The NHS White Paper 1997 made recommendations that ‘clinical governance’ is embraced so that quality is at the core, that quality improvement processes such as clinical audit are in place, that evidence based practice is in day to day use with the infrastructure to support it, and that clinic settings were beneficial for the treatment of chronic conditions.

A leg ulcer prevalence study in 1999 carried out by the NHS Clinical Audit demonstrated that blank had the highest incidence of leg ulcers within the trust and it was decided that the best way forward was to set up nurse led community leg ulcer clinics.

The establishment of nurse lead community leg ulcer clinics was happening up and down the country as a result of the government initiative...