Implementing Venous Leg Ulcer Education and Clinical Decision Support: A Quality Improvement Project

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BACKGROUND: Venous leg ulcers (VLU) require early identification and treatment to prevent further harm. Health care providers often fail to initiate evidenced-based VLU treatment promptly because of a lack of knowledge of VLU guidelines. PURPOSE: To improve early treatment for patients with VLUs presenting to outpatient clinic settings. METHODS: Plan-DoStudy-Act cycles were used for this quality improvement project. Virtual education and a comprehensive clinical decision support (CDS) order set were implemented. Outcome metrics included the rate of ankle-brachial index (ABI) testing, mechanical compression therapy, and home health service referrals for patients with VLUs. The frequency with which the CDS order set was used was also measured. RESULTS: Forty health care providers attended the virtual education sessions among 3 outpatient clinics. There was an increase in ankle-brachial index testing from pre (n = 7; 15.9%) to post (n = 10; 18.2%) (P =.796), but there was a decline in mechanical compression therapy from pre (n = 15; 34.1%) to post (n = 4; 7.3%) (P =.002) and home health service referrals from pre (n = 11; 25%) to post (n = 9; 16.4%) (P =.322). The CDS order set was used 9 times over 13 weeks. CONCLUSION: Future Plan-Do-Study-Act cycles will include completing in-person education and reducing the VLU CDS order set length. Future projects should consider these approaches when implementing evidence-based VLU guidelines.






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Beatty, Amelia, Penny S Jones, Christopher Vail, Julie A Thompson and Staci S Reynolds (2022). Implementing Venous Leg Ulcer Education and Clinical Decision Support: A Quality Improvement Project. Wound Management and Prevention, 68(9). pp. 12–18. 10.25270/wmp.2022.9.1218 Retrieved from

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Staci Reynolds

Clinical Professor in the School of Nursing

Dr. Staci Reynolds joined Duke in January 2016, with a joint position between Duke University School of Nursing and Duke University Hospital (DUH).  At DUSON, Dr. Reynolds teaches in the ABSN Program (neuroscience nursing) and DNP program (healthcare quality improvement methods).  Clinically, she served as a neuroscience Clinical Nurse Specialist (CNS) for the inpatient neuro units at DUH from 2016 - 2019 and for the Infection Prevention and Hospital Epidemiology department from 2019 - 2023. Dr. Reynolds coordinated the Duke Advancement of Nursing, Center of Excellence (DANCE) academic-practice partnership from 2016 - 2023, and was the faculty lead for the post-DNP Quality Implementation Scholars Program from 2019 - 2022.  In January 2023, Dr. Reynolds was appointed the Editor-in-Chief of the Journal of Nursing Care Quality.  Before coming to DUSON, she was a neuro critical care nurse and a neuroscience Clinical Nurse Specialist at Indiana University Health Methodist Hospital.

Dr. Reynolds received a baccalaureate degree in nursing science from Indiana University (IU) in Indianapolis, Indiana.  She earned a Master’s degree as a Clinical Nurse Specialist at IU in 2011, and completed her PhD at IU in May 2016.  Dr. Reynolds’ dissertation focused on implementation of clinical practice guidelines, and her current research interests includes evidence-based practice implementation and quality improvement.

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