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Guidelines in Practice: The Effect on Healing of Venous Ulcers

McGuckin, Maryanne Dr ScEd, MT (ASCP); Williams, Liz BA, DN; Brooks, Jill BA (HONS, RGN, DN); Cherry, George PhD

Features: Original Investigation

OBJECTIVE: To determine the effect of guidelines on vascular assessment, compression usage, dressing selection, and healing rates of patients with a venous ulcer.

DESIGN: Prospective descriptive intervention evaluation.

SETTING: Oxfordshire Community National Health Service (NHS) Trust, United Kingdom.

PATIENTS: 40 consecutive prospective patients seen by Oxfordshire district nurses, either at home or at a wound clinic coordinated by district nurses located in a surgery office.

INTERVENTION: The Guideline for Diagnosis and Treatment of Venous Leg Ulcers (University of Pennsylvania) and the Oxfordshire Leg Ulcer Guideline.

MAIN OUTCOME MEASURES: Time to healing, compliance with vascular assessment, compression usage, and nursing costs.

MAIN RESULTS: 91% of patients had a vascular assessment; all patients were treated with compression. Mean time to healing was 8 weeks and was not related to dressing selection or type of compression (short- versus long-stretch bandage). Nursing costs were slightly higher for wounds that healed after 12 weeks and were treated with a long-stretch bandage (£170.00 [$250.00] vs £272.00 [$395.00]).

CONCLUSION: Use of compression was influenced by guidelines that emphasize a vascular assessment. Choice of dressing or type of compression was not a significant factor in healing rates.

Maryanne McGuckin, Dr ScEd, MT (ASCP), is Senior Research Investigator at the University of Pennsylvania School of Medicine, Philadelphia, PA. Liz Williams, BA, DN, is a District Nurse at Abingdon, Malthouse Health Center, Abingdon, UK. Jill Brooks, BA (HONS, RGN, DN), is Primary Care Development Coordinator at Oxfordshire Community National Health Service (NHS) Trust, Witney, Oxon, UK. George Cherry, PhD, is Director of Clinical Measurement, Wound Healing Institute, Churchill Hospital, Headington, Oxford, UK.

The authors thank the district nurses from Oxfordshire Community NHS Trust and acknowledge the support of Madeline Carroll, MSA, Scientific and Regulatory Affairs, and Patricia Kaczala, Medical Education Advisor, at Beiersdorf-Jobst, Inc, Charlotte, NC, and Lois Porten, University of Pennsylvania, for manuscript assistance.

This study was supported in part by a grant from Beiersdorf-Jobst, Inc, Charlotte, NC.

© 2001 Lippincott Williams & Wilkins, Inc.