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

Abstract

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.