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Advances in Skin & Wound Care:
doi: 10.1097/01.ASW.0000428866.80036.fd
Departments: Practice Points

Venous Etiology Clinical Pathways Integrated with Evidence-Based Decisions: Part 1

Hess, Cathy Thomas BSN, RN, CWOCN

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Author Information

Cathy Thomas Hess, BSN, RN, CWOCN, is Vice President and Chief Clinical Officer, Net Health Systems, Inc. Please address correspondence to: Cathy Thomas Hess, BSN, RN, CWOCN, via e-mail: cthess@nhsinc.com.

Management of vascular ulcers has improved over the past decade as clinicians have realized the importance of proactive measures and a multidisciplinary team approach. About 1% of the general population and 3.5% of people older than 65 years have venous leg ulcers, and the number is rising as the population ages. The recurrence rate of venous ulcers is nearly 70%. It is estimated that the cost of care for venous ulcers exceeds $40,000 per episode. With an estimated 2.5 million Americans with venous ulcers, the total cost of treatment may be as high as $3.5 billion annually. As many as 2 million workdays per calendar year are lost because of chronic venous ulcers. Moreover, venous ulcers are believed to account for 70% to 90% of chronic leg ulcers. These ulcers can be difficult to heal. The incidence of venous ulceration increases with age, with women being 3 times more likely than men to develop venous leg ulcers. In some studies, 50% of patients had venous ulcers that persisted for more than 9 months, and 20% had ulcers that did not heal for more than 2 years. After healing, more than 60% of patients experienced a recurrence of venous ulcers.

To review, the clinical pathway provides clinical and operational direction in a stepwise fashion for the team to follow when performing a comprehensive patient assessment. The assessment details the patient’s medical history, inclusive of the wound’s status. To complete each step, consider appropriate personnel through a clinical and operational workflow synchronization model. The pathway should provide information regarding an initial assessment. Follow-up visits will be predicated on the department’s clinical and operational workflow, policies and procedures, and the necessary medical/clinical direction based on the patient and his/her wound presentation. As discussed in previous columns, an effective tool for managing outcomes is the clinical pathway. This column, with select references, focuses on the Venous Ulcer Pathway Week 1. Subsequent columns will review the pathways for weeks 4 and 20.

Source: Hess CT. Clinical Guide: Skin and Wound Care. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2012.

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References

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1. Robson MC, Cooper DM, Rummana A, et al.. Guidelines for the treatment of venous ulcers. Wound Repair Regeneration 2006; 14: 649–62.

2. Registered Nurses Association of Ontario (RNAO). Assessment and management of venous leg ulcers. http://rnao.ca/bpg/guidelines/assessment-and-management-venous-leg-ulcers. Last accessed February 26, 2013.
3. Falanga V, Margolis D, Alvarez O, et al.. Rapid healing of venous ulcers and lack of clinical rejection with allogeneic cultured human skin equivalent. Arch Dermatol 1998; 134: 293–300.

© 2013 Lippincott Williams & Wilkins, Inc.

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