Getting lower leg ulcer evidence into primary health care nursing practice: a case study
Venous leg ulcers (VLUs) are open lesions on the lower leg caused by venous disease, which are associated with high morbidity and pose a challenge to manage effectively (Scottish Intercollegiate Guidelines Network, 2010). Gold standard treatment for VLUs is graduated compression therapy to aid venous return. This paper presents an approach to the challenging management of VLUs that is based on a problem, and subsequent local audit. We use a case study that illustrates a collaborative approach to determine gaps in evidence-based practice (EBP), and a nurse-led initiative in consultation with executive managers and doctors. In our sample, 40% of patients had not consulted a vascular specialist. They did not have a formal diagnosis of leg ulcer aetiology and therefore had not received optimum treatment. Access and cost were main factors impacting on leg ulcer care. Nurses providing evidence-based management of VLUs should ensure collaboration with key stakeholders. This assists in implementing diagnosis of ulcer aetiology for best practice measures. At this local health district, a change in policy to reflect EBP for VLU management in primary health care has been achieved.