Venous Leg Ulcer Care Pathway

Venous Leg Ulcer Outcome-Based Pathway
Pathway Identification
Pathway Name
Presenting Issue or
Condition Defined
Exclusion Criteria
Overall Pathway Outcome
Reason for Stoppage
Venous Leg Ulcer
(venous stasis ulcer, venous insufficiency ulcers) a wound caused by
impairment in the flow of venous blood from the legs to the heart.
This impairment is associated with venous hypertension as a result of one
or a combination of the following:
 valve dysfunction (reflux)
 blockage of the veins (i.e. clot)
 "failure of the calf muscle pump function" (i.e. paraplegia, MS or
altered gait)
o Intact skin (without visible injury or opening e.g. cellulitis)
o Wound closed
o Wound closed
o Supervening event:
o Transfer to other CCAC
o Admission to hospital >14 days
o Admission to a LTCH
o Death
o Vacation away from home >14 days
o Patient refuses care
o Moved to a different pathway
o List reason:
o New pathway:
o Other:
1v5 - 20130925
© Community Care Access Centre/Centre d’accès aux soins communautaires and Ontario Association of Community Care Access
Centres/Association des Centres d’accès aux soins communautaires de l’Ontario, 2013. All rights reserved. Unauthorized
distribution and duplication strictly prohibited.
Page 1 of 5
Venous Leg Ulcer Outcome-Based Pathway
Pathway Evaluation
Date Created
Date Reviewed
(Subject Matter Experts)
Subject Matter Experts
November 10, 2011
January 10, 2012 – February 21, 2012
o
o
o
o
o
o
o
o
o
o
Date of Endorsement by
Provincial Patient
Services Committee
Frequency of Review
Next Review Date
What triggers a special
condition review of
pathway
Ontario Home Care Association & Ontario Community Support
Association (OHCA-OCSA), Nursing Practice Council (NPC)
OHCA-OCSA, Therapy Advisory Group (TAG)
Catherine Harley, Canadian Association of Enterostomal Therapy
(CAET) Executive Director
Dr. Gary Sibbald, Women’s College Hospital (WCH), Director of Wound
Healing Clinic, Director of Medical Education
Dr. Kevin Woo, Advanced Wound Consultant, West Park Health Centre
Heather McConnell, Registered Nurses Association of Ontario (RNAO),
International Affairs & Best Practice Guidelines (IABPG) Associate
Director
Mariam Botros, WCH, Chiropody
Patricia Coutts, WCH, Wound Healing Centre
Peggy Ahearn, Canadian Association of Wound Care (CAWC),
Executive Director
Rhona McGlasson, Sunnybrook Health Sciences Centre, Executive
Director
June 29, 2012
TBD based on RNAO and CAWC guidelines
May 2014
o Criteria for special condition review will be determined based upon
results obtained from the OBP/OBR pilot starting in Fall 2012.
1v5 - 20130925
© Community Care Access Centre/Centre d’accès aux soins communautaires and Ontario Association of Community Care Access
Centres/Association des Centres d’accès aux soins communautaires de l’Ontario, 2013. All rights reserved. Unauthorized
distribution and duplication strictly prohibited.
Page 2 of 5
Venous Leg Ulcer Outcome-Based Pathway
Best Practice
Guideline
Interval
Outcome
o
0 to 7 Days
Holistic patient
and wound
assessment
completed
Outcome
Evaluation
Reporting
o
SPO
o
Outcome
not met
Barriers to Outcome
Achievement
o
o
o
o
Lower limb
assessment
completed
o
SPO
o
Outcome
not met
CAWC: Venous Leg
Ulcer Best Practice
Recommendations
o
RNAO: Assessment
and Management of
Venous Leg Ulcers
o
Correct outcomebased pathway
confirmed
o
Compression
therapy initiated
o
SPO
SPO
o
o
Outcome
not met
Outcome
not met
o
o
o
o
o
o
o
o
o
o
o
Follow up Actions
Resource barriers
o Patient
o SPO
o CCAC
o System
Patient declined
Other:
o
Resource barriers
o Patient
o SPO
o CCAC
o System
Patient declined
Other:
Inaccurate diagnosis on
referral
Incomplete SPO report
Unknown etiology
Other:
Patient contraindication
Resource barriers
o Patient
o SPO
o CCAC
o System
Patient declined
Other:
o
o
o
o
o
o
o
o
o
o
o
o
CC system navigation to
address resource
barriers
Contact patient /
caregiver re: rationale
Other:
CC system navigation to
address resource
barriers
Contact patient /
caregiver re: rationale
Other:
Follow-up with SPO for
report completion
Discontinue pathway
Other:
Inter-professional
referrals based on
contraindications
CC system navigation to
address resource
barriers
Contact
patient/caregiver re:
rationale
Other:
1v5 - 20130925
© Community Care Access Centre/Centre d’accès aux soins communautaires and Ontario Association of Community Care Access Centres/Association des Centres d’accès aux soins
communautaires de l’Ontario, 2013. All rights reserved. Unauthorized distribution and duplication strictly prohibited.
Page 3 of 5
Venous Leg Ulcer Outcome-Based Pathway
Best Practice
Guideline
Interval
Outcome
o
0 to 7 Days
Wound therapy
initiated
Outcome
Evaluation
Reporting
o
SPO
o
Outcome
not met
Barriers to Outcome
Achievement
o
o
o
o
o
Discharge
planning initiated
for patient
independence and
prevention
o
SPO
o
Outcome
not met
o
o
o
Patient contraindication
Resource barriers
o Patient
o SPO
o CCAC
o System
Patient declined
Other:
Non-adherence to BPG
o Patient
o SPO
o CCAC
Patient declined
Other:
Follow up Actions
o
o
o
o
o
o
o
o
21 to 28 days
o
CAWC: Venous Leg
Ulcer Best Practice
Recommendations
20-30% reduction
in wound size
o
SPO
o
Outcome
not met
o
o
o
RNAO: Assessment
and Management of
Venous Leg Ulcers
Causative factors
o Internal
o External
Non-adherence to BPG
o Patient
o SPO
o CCAC
Other:
o
o
o
o
o
o
Inter-professional
referrals to address
contraindications
CC system navigation to
address resource
barriers
Contact patient /
caregiver re: rationale
Other:
Consult with SPO / ET /
Wound Care Specialist
Inter-professional
referrals as required
CC system navigation
as required
Contact
patient/caregiver re:
rationale
Other:
Consult with SPO ET /
Wound Care Specialist
and review / update
care plan as required
Validate use of BPG
Inter-professional
referrals as required
Consider transfer to
another pathway
Other:
1v5 - 20130925
© Community Care Access Centre/Centre d’accès aux soins communautaires and Ontario Association of Community Care Access Centres/Association des Centres d’accès aux soins
communautaires de l’Ontario, 2013. All rights reserved. Unauthorized distribution and duplication strictly prohibited.
Page 4 of 5
Venous Leg Ulcer Outcome-Based Pathway
Best Practice
Guideline
Interval
21 to 28 days
Outcome
o
Referral initiated
for long-term
compression
system
Outcome
Evaluation
Reporting
o
SPO
o
Outcome
not met
Barriers to Outcome
Achievement
o
o
o
o
77 to 84 days
Or upon
discharge
CAWC: Venous Leg
Ulcer Best Practice
Recommendations
o
Wound is closed
by 12 weeks
o
SPO
o
Outcome
not met
o
o
RNAO: Assessment
and Management of
Venous Leg Ulcers
91 to 98 days
Or upon
discharge
o
o
Patient is
independent with
long-term
compression
system by week
14
o
SPO
o
Outcome
not met
o
o
o
Patient readiness for
compression fitting
o Psychological
o Physiological
Prescription not
obtained
Resource barriers
o Patient
o SPO
o CCAC
o System
Other:
Causative factors
o Internal
o External
Non-adherence to BPG
o Patient
o SPO
o CCAC
Other:
Patient/caregiver
capacity
Resource barriers
o Patient
o SPO
o CCAC
o System
Other:
Follow up Actions
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Psychological readiness
- Contact patient
Physiological readiness
– re-evaluate in
consultation with SPO /
Consult with SPO
ET/Wound Care
Specialist
Consult with SPO
and/or physician
CC system navigation
as required
Other:
Consult with SPO / ET /
Wound Care Specialist
and review / update
care as required
Validate use of BPG
Inter-professional
referrals as required
Consider transfer to
another pathway
Other:
CC system navigation
as required
Contact
patient/caregiver
Inter-professional
referrals as required
Other:
1v5 - 20130925
© Community Care Access Centre/Centre d’accès aux soins communautaires and Ontario Association of Community Care Access Centres/Association des Centres d’accès aux soins
communautaires de l’Ontario, 2013. All rights reserved. Unauthorized distribution and duplication strictly prohibited.
Page 5 of 5