BACKGROUND

Leg and foot ulcers are disabling and constitute a significant burden on patients and the healthcare system.  Community-based care for people with leg ulcers is often fragmented and inconsistent, leading to prolonged healing times and ineffective use of resources.  Proficient care for people with chronic wounds ulcers requires an interprofessional team working together.  Best practice guidelines must be transferred and integrated into practice to promote best outcomes.   The purpose of this project is to demonstrate how best practice guidelines can be translated into clinical practice.

METHODS

In this longitudinal study, 111 patients were followed prospectively for 4 weeks in 2006.  A total number of 78 leg ulcers and 96 foot ulcers evaluated at the beginning and 66 leg ulcers (85.9%) and 85 foot ulcers (88.5%) were evaluated at the end of the study. All subjects were referred by home care agencies in Ontario.  

RESULTS

We compared the wound surface areas at week one and four to determine the relative healing rate.  By addressing the wound etiology and following the best practice recommendations of the wound type, majority of the wounds improved.  The surface areas were significantly reduced from 29.05 cm² to 13.97 cm² at week 4 (t= 2.67; p=0.01) in the leg ulcer group and from 4.5 cm² to 2.95 cm² in the foot ulcer population. 

APPLICATION AND FUTURE DIRECTIONS

The presence of best practice recommendations without a systematic implementation policy is insufficient to improve the standard of care for clients with leg and foot ulcers.  

Results strongly suggest a need to develop local transprofessional assessment wound care team to deliver wound care. We propose the creation of a specialized community-based interprofessional wound assessment and treatment plan on all open leg and foot ulcers at the time of admission to home care.

Sibbald RG, Orsted HL, Coutts PM, Keast DH. Best Practice Recommendations for Preparing the Wound Bed: Update 2006. Wound Care Canada 2006; Vol. 4 No. 1: R6-R18.

Moffatt CJ, Franks PJ. Implementation of a leg ulcer strategy. British Journal of Dermatology 2004; 151: 857-867.

Gottrup F, Holstein P, Jorgensen B, Lohmann M, Karlsmar T. A New Concept of a Multidisciplinary Wound Healing Center and a National Expert Function of Wound Healing. American Medical Association July 2001; 136: 765-772.