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Lower Extremity Wound Pathway

The Lower Extremity Wound Pathway addresses identification, assessment and management of patients with chronic leg and foot wounds associated with poor circulation. These include venous stasis ulcers, arterial ulcers, and diabetic foot ulcers.

The purpose of the pathway is to support improved outcomes for these patients in the form of shorter healing times and reduced incidence of hospitalization and amputation.

This pathway is in the development phase. Orientation to pathway tools and protocols will start in March 2016 with community nurses and primary care providers, and will build up to coordinated multidisciplinary teams.

Implementation of the pathway is intended to support care providers through:

  • Updated standardized wound protocols and tools for wound tracking;
  • Improved access to multidisciplinary providers and services;
  • Tools for communication among multidisciplinary providers; and
  • Capacity-building for community nurses.

Pathway Triage

The Lower Extremity Wound Pathway recommends three plans of care:

Red flags are present: Urgent referral to on-call specialist and/or send to nearest ER. Red flags include significant ischemia, systemic infection, or a deep, gangrenous wound.

Diabetic ulcer: Referral to vascular specialist for assessment. Referral to home care can be made at the same time for initiation of treatment.

Venous stasis ulcer: Referral to regional homecare for treatment as per protocol.

Referral Form

The Lower Extremity Wound (LEW) Pathway referral form is intended to assist primary care providers with assessment and triage, while helping collect useful information for sharing with other providers. LEW referrals can be sent to regional homecare or to a vascular specialist, or both (in the case of diabetic ulcers). Regional homecare will provide timely feedback to referring providers using the pathway communications form.

LEW Pathway Referral Form
Primary Care Communications Form

Treatment Protocols

Providers who manage wounds in primary care should consider following pathway standardized treatment protocols, and involve other care providers as appropriate in leg and wound assessment, compression and/or pressure offloading.

Lower Leg Assessment Form
Neuropathic and Diabetic Foot Ulcer Protocol
Venous Stasis Ulcer Protocol
Treatment Protocol for Arterial/Non-Healable Wounds
Product Formulary
Updated Wound Record (WR-145.0) Please order from NISS

Continuing Education

Nursing education:

Care of the Patient with Lower Extremity Wounds, developed by SK Polytechnic for the Lower Extremity Wound Pathway. This course is 50-60 hours of web-based, self-directed learningwith a hands-on lab at the end. Location of labs will vary depending on location of the majority of students. For more information contact nursingconed@saskpolytech.ca or visit www.saskpolytech.ca/CE

Note that the Lower Extremity Wound Pathway does not provide direct support to nurses to take this course. Funding, if available, is provided through regional health authorities to selected nurses.

Medical education:

Primary Assessment of Lower Extremity Wounds, developed by Dr. Tessa Laubscher physician co-chair of Lower Extremity Wound Pathway. This 45-minute seminar can be delivered in conference settings or live via webex. For more information or to book a seminar, contact lori.latta@health.gov.sk.ca.

In-service/orientation:

Introduction to the Lower Extremity Wound Pathway:LEW feet
This 2.5-hour e-learning seminar was produced by the University of Saskatchewan College of Nursing Continuing Education Department in March 2016. This orientation provides regional personnel and care providers with an overview of the LEW Pathway goals and an introduction to the use of standardized tools and protocols. View the seminar on the CEDN YouTube channel here: https://www.youtube.com/channel/UCVdqJ8t7U7BvvkJgJ2qAYoA

Information for Patients

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