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{{org_field_name}}

Registration Number: {{org_field_registration_no}}

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Leg Ulcer Management and Prevention Policy

1. Purpose and Commitment

The purpose of this policy is to set out how {{org_field_name}} will support the prevention, identification, monitoring and safe management of leg ulcers in people receiving domiciliary care services.

{{org_field_name}} will provide care and support in a manner that protects service users from avoidable harm and ensures that risks associated with skin integrity, wounds and leg ulcers are identified, documented, communicated and escalated appropriately.

This policy must be implemented in accordance with:

• the Health and Social Care Act 2008;
• the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as amended, including in particular Regulations 9, 11, 12, 17 and 18;
• the Mental Capacity Act 2005, where applicable;
• applicable infection prevention and control requirements;
• current Care Quality Commission guidance; and
• current nationally recognised clinical guidance relevant to leg ulcer care, including applicable NICE guidance.

Care workers must not diagnose the cause or type of a leg ulcer, undertake vascular assessment, select clinical wound treatments, commence compression therapy or perform any other clinical procedure unless that activity falls within their role and the organisation’s regulated scope, has been appropriately authorised or delegated where required, and the worker has received the necessary training and has been assessed as competent to perform the specific task safely.

Where assessment, diagnosis or treatment requires a registered healthcare professional, {{org_field_name}} will ensure that concerns are referred or escalated promptly to an appropriate healthcare professional and that any instructions relevant to the domiciliary care service are incorporated into the service user’s care plan.

2. Scope

This policy applies to all employees, including care staff, administrative staff, volunteers, contractors, and agency workers involved in providing care to service users. It covers:

• Prevention of leg ulcers.
• Identification and assessment of leg ulcers.
• Treatment, management, and monitoring.
• Education and support for service users and their families.

The policy applies across all domiciliary care settings, ensuring consistency in care delivery and adherence to best practices.

3. Policy Statement

{{org_field_name}} is committed to:

• Promoting early detection and prevention of leg ulcers.
• Delivering evidence-based wound care.
• Ensuring staff are trained and competent in leg ulcer management.
• Educating service users on self-care and prevention strategies.
• Collaborating with healthcare professionals for holistic care.

We adopt a person-centred approach, ensuring that service users’ preferences, dignity, and well-being are prioritised.

4. Understanding Leg Ulcers

4.1 Definition of Leg Ulcers

Leg ulcers are open wounds that occur on the lower leg, typically between the knee and ankle, and fail to heal within six weeks. They are often caused by underlying health conditions such as venous insufficiency, arterial disease, diabetes, or pressure damage.

4.2 Types of Leg Ulcers

• Venous Ulcers: Caused by poor venous circulation, often characterised by shallow wounds with irregular edges and associated with swelling and skin discoloration.
• Arterial Ulcers: Result from reduced arterial blood flow, presenting as deep, well-defined wounds, often painful and located on pressure points.
• Diabetic Ulcers: Associated with diabetes, typically on the feet or lower legs, caused by neuropathy and poor circulation.
• Pressure Ulcers: Develop due to prolonged pressure, commonly on bony areas.

4.3 Risk Factors

Risk factors include:

• Poor circulation (venous or arterial).
• Diabetes and peripheral neuropathy.
• Immobility and pressure damage.
• Obesity and poor nutrition.
• Advanced age and frailty.

5. Prevention Strategies

5.1 Risk Assessment

We conduct comprehensive risk assessments for all service users upon admission and regularly thereafter. This includes:

• Evaluating medical history and underlying conditions.
• Assessing skin integrity and circulation.
• Identifying mobility limitations and nutritional status.

5.2 Skin Care and Hygiene

Proper skin care reduces the risk of ulcer formation. Staff ensure that:

• Skin is kept clean, moisturised, and dry.
• Regular skin inspections are conducted.
• Appropriate continence management is in place.

5.3 Mobility and Pressure Relief

Promoting mobility and reducing pressure are key prevention strategies:

• Encouraging regular movement and repositioning.
• Using pressure-relieving devices, such as cushions and mattresses.
• Supporting safe exercise within service users’ abilities.

5.4 Nutrition and Hydration

Adequate nutrition and hydration support skin integrity and wound healing. Staff promote:

• A balanced diet rich in protein, vitamins, and minerals.
• Adequate fluid intake.

5.5 Health Promotion and Education

We educate service users and families on:

• Maintaining healthy circulation.
• Recognising early signs of skin breakdown.
• Practicing proper foot and leg care.

6. Identification and Assessment

6.1 Early Identification and Observation

Staff must remain alert to changes in the service user’s lower limbs and skin where this is relevant to the person’s assessed needs and care plan.

Staff must observe for and report changes including:

• newly broken or ulcerated skin;
• redness or swelling;
• changes in skin colour;
• increased warmth;
• new or increasing pain or tenderness;
• increased or unusual wound leakage;
• bleeding;
• offensive or unusual odour;
• deterioration in an existing wound;
• increasing swelling of the leg;
• signs that the service user is becoming systemically unwell; or
• any other significant change from the person’s normal presentation.

Care workers must record relevant observations promptly and report concerns in accordance with the person’s care plan and the organisation’s escalation procedures.

Staff must not make an independent diagnosis of a venous, arterial, diabetic or other type of leg ulcer unless they are appropriately qualified, competent and authorised to undertake that clinical assessment.

6.2 Clinical Assessment and Referral

Where a new wound, suspected leg ulcer, deterioration of an existing ulcer or other clinically significant concern is identified, an appropriate healthcare professional must be contacted in accordance with the level of urgency.

Clinical assessment of a leg ulcer, including diagnosis of the underlying cause, vascular assessment, ankle brachial pressure index or other Doppler assessment, determination of wound treatment and decisions concerning compression therapy, must be undertaken by an appropriately qualified and competent healthcare professional or other person who is specifically authorised and competent to undertake the relevant clinical procedure.

Where {{org_field_name}} does not employ the healthcare professional responsible for the clinical assessment or treatment, staff must work with the relevant GP, district or community nursing service, tissue viability service, podiatry service or other appropriate healthcare professional.

The outcome of professional assessment and any instructions relevant to care delivered by {{org_field_name}} must be documented in the service user’s care plan before staff undertake the instructed intervention, except where immediate action is necessary to protect the person from harm.

6.3 Documentation and Wound Images

Staff must maintain an accurate, complete and contemporaneous record of:

• observations made;
• changes in skin or wound condition;
• pain or other symptoms reported by the service user;
• concerns identified;
• action taken;
• referrals or escalations made;
• advice or instructions received from healthcare professionals;
• treatment or delegated care actually provided by {{org_field_name}}; and
• the service user’s response to the care provided.

Wound photography must only be undertaken where it is necessary for the person’s care, is permitted by organisational procedure, and appropriate consent or other lawful authority is in place.

Images must be taken, transferred, stored, accessed and shared securely in accordance with the organisation’s information governance and data protection procedures. Staff must not use personal mobile telephones or other unauthorised devices to photograph service users or their wounds.

6.4 Consent, Mental Capacity and Refusal of Care

Care and treatment must only be provided with the consent of the relevant person in accordance with Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Service users must be given information relevant to the care being offered in a form they can understand and must be supported to participate in decisions about their care and treatment.

Where there is reason to doubt a service user’s capacity to make a particular decision, staff must follow the Mental Capacity Act 2005 and the organisation’s Mental Capacity and Consent Policy. Capacity must not be assumed to be absent solely because a person makes a decision that others consider unwise.

Where a person with capacity refuses wound care, assessment, referral, compression or another intervention, their decision must be respected. Staff must document the refusal, explain relevant risks within the limits of their role, notify the appropriate manager and healthcare professional where necessary, and take reasonable steps to reduce foreseeable harm without providing treatment against the person’s wishes.

7. Treatment and Management

7.1 Individualised Care and Treatment Plan

Where a service user has a leg ulcer, the care and support provided by {{org_field_name}} must be based on the person’s assessed needs, preferences, consent and current care plan.

Where clinical wound treatment is required, the relevant parts of the care plan must reflect the assessment, treatment plan and instructions provided by an appropriately qualified healthcare professional.

The care plan must clearly identify:

• the person’s leg ulcer-related needs and risks;
• which healthcare professional or service has clinical responsibility for wound management;
• what care or treatment {{org_field_name}} is responsible for providing;
• the specific actions staff are authorised to undertake;
• the frequency of any authorised intervention;
• equipment, dressings or products to be used where applicable;
• precautions or contraindications communicated by the healthcare professional;
• signs of deterioration or complications that staff must monitor for;
• escalation arrangements; and
• review arrangements.

Staff must not independently amend a clinical wound treatment plan.

7.2 Wound Care and Delegated Clinical Tasks

Wound cleansing, dressing changes, compression application or any other clinical wound-care activity may only be undertaken by staff where:

• the activity is within the organisation’s regulated scope and the worker’s role;
• there is a current documented care or treatment plan;
• where appropriate, the task has been specifically delegated or authorised by an appropriate healthcare professional;
• clear written instructions are available;
• the staff member has received appropriate training;
• the staff member has been assessed as competent for the specific activity;
• the staff member understands the circumstances in which they must stop the procedure and seek professional advice; and
• the service user has consented or another lawful basis for the care is in place.

Staff must follow the current treatment instructions exactly and must not independently select, substitute or alter wound dressings, topical preparations, compression systems or other clinical treatments.

Where instructions are missing, unclear, contradictory or appear inconsistent with the person’s current condition, staff must not guess or improvise. Advice must be obtained from the responsible healthcare professional before proceeding unless immediate action is required to prevent serious harm.

7.3 Compression Therapy

Staff must not independently commence, prescribe, select or alter compression therapy.

Compression therapy must only be provided where it forms part of an individual treatment plan following appropriate clinical assessment and where the person applying or assisting with the compression is appropriately trained, competent and authorised to do so.

Where a care worker has been authorised to assist with or apply prescribed compression, the care plan must clearly state:

• the compression system or garment to be used;
• when it must be applied and removed;
• any specific precautions;
• what observations staff must make;
• circumstances requiring removal or cessation of treatment; and
• when and how professional advice must be obtained.

New or significantly increased pain, unusual colour change, coldness of the foot or limb, new numbness, loss of sensation, marked swelling, or any other concern suggesting compromised circulation must be treated as a clinical concern and escalated promptly in accordance with the service user’s care plan and emergency procedures.

7.4 Infection Prevention and Recognition of Possible Infection

Staff undertaking any wound-related activity must follow the organisation’s infection prevention and control procedures, including appropriate hand hygiene, use of personal protective equipment and safe management and disposal of waste.

Staff must be aware that the presence of bacteria in a leg ulcer does not by itself mean that the ulcer is clinically infected.

Possible signs of clinically significant infection may include:

• redness or swelling spreading beyond the ulcer;
• increased localised warmth;
• new or increasing pain;
• fever or other signs of systemic illness; or
• significant deterioration in the person’s condition.

Staff must promptly report suspected infection or deterioration to an appropriate healthcare professional.

Urgent medical assistance must be obtained where the person is acutely unwell or there are signs of serious infection, rapidly worsening symptoms, severe pain out of proportion to the appearance of the wound, suspected sepsis, suspected limb ischaemia or any other medical emergency.

Care workers must not diagnose wound infection or initiate antimicrobial treatment unless appropriately qualified and authorised to do so.

7.5 Pain Management

Pain must be assessed through discussion with the service user and observation appropriate to the person’s communication needs.

Staff must:

• document new, increasing or uncontrolled pain;
• report significant changes promptly;
• support the service user to take prescribed analgesia where this forms part of the agreed medicines support plan; and
• seek appropriate healthcare advice where pain is persistent, worsening, severe or inconsistent with the person’s usual presentation.

Staff must not introduce unprescribed clinical treatments or remedies for leg-ulcer pain unless these have been specifically assessed as appropriate and included in the person’s care plan.

8. Monitoring and Escalation

8.1 Monitoring

Where monitoring of a leg ulcer or surrounding skin forms part of the service user’s care plan, staff must make and record the observations specified in that plan.

Monitoring may include, where staff have been instructed and are competent to do so:

• changes in the appearance of the wound or surrounding skin;
• changes in wound leakage;
• changes in swelling;
• pain reported by the service user;
• signs of possible infection;
• tolerance of prescribed treatment;
• condition of prescribed dressings or compression systems; and
• changes in the person’s general health or well-being.

Formal wound measurement, photography, clinical wound assessment or other clinical monitoring must only be undertaken by a person who is competent and authorised to undertake that activity.

Staff must accurately document their observations and any care delivered and must communicate relevant changes to the person or service responsible for the service user’s clinical wound management.

8.2 Escalation of Concerns

Staff must escalate concerns promptly where:

• a new wound or ulcer is identified;
• an existing wound deteriorates;
• healing does not appear to be progressing as expected;
• there are signs of infection;
• pain develops or increases;
• there is a significant change in the colour, temperature, sensation or swelling of the limb;
• prescribed dressings or compression cannot be applied as instructed;
• the service user repeatedly declines clinically important care or assessment;
• the person’s general condition deteriorates; or
• staff have any concern that the current care plan is no longer safe or appropriate.

Depending on the nature and urgency of the concern, escalation may be to the GP, district or community nurse, tissue viability service, podiatry service, NHS 111, emergency services or another appropriate healthcare professional.

Staff must request or facilitate professional review rather than independently determining that a particular diagnostic investigation, such as Doppler or ankle brachial pressure index assessment, is required.

Where an urgent or emergency condition is suspected, staff must follow the organisation’s emergency escalation procedure without delay.

All referrals, escalation actions, advice received and resulting changes to the care plan must be recorded.

9. Collaboration with Healthcare Professionals

9.1 Multidisciplinary Approach

Effective leg ulcer management requires collaboration with:

• General practitioners (GPs).
• District nurses and tissue viability specialists.
• Dietitians and physiotherapists.
• Podiatrists for foot care and offloading strategies.

9.2 Care Coordination

Staff ensure seamless communication between healthcare providers, service users, and families through regular case reviews and updates.

10. Education and Empowerment

10.1 Service User Education

Service users must be supported to understand their leg ulcer-related care in a way that meets their individual communication needs.

Within the limits of their role, staff may support service users to understand:

• the importance of reporting changes in their leg or wound;
• signs or symptoms that require healthcare advice;
• agreed skin and leg care measures;
• prescribed or professionally recommended treatment;
• the importance of following the agreed care plan;
• mobility or positioning advice contained in the care plan; and
• healthy lifestyle measures relevant to their agreed care.

Clinical advice concerning diagnosis, treatment choices, compression therapy, wound products or other specialist interventions must be provided by an appropriately competent healthcare professional.

10.2 Family and Carer Involvement

Family members, unpaid carers or representatives may be involved in the service user’s care where the service user consents to their involvement or there is another lawful basis for that involvement.

Information must only be shared with relatives or carers in accordance with the person’s wishes, confidentiality requirements and applicable data protection law.

Where a family member or unpaid carer undertakes wound-related care independently of {{org_field_name}}, responsibility for that activity must be clearly identified in the service user’s care plan.

Staff must not instruct a family member or unpaid carer to undertake a clinical wound-care activity unless this forms part of an appropriately agreed treatment arrangement and the necessary advice, training or instruction has been provided by a competent healthcare professional.

Any concern about the safety or effectiveness of wound care being provided by another person must be recorded and escalated appropriately.

11. Training and Competence

11.1 Role-Appropriate Training

Staff must receive training and information appropriate to their role and responsibilities.

Staff who provide personal care to service users at risk of skin breakdown or leg ulceration must have sufficient knowledge to:

• recognise and report changes in skin integrity;
• understand their responsibility to observe, record and escalate concerns;
• understand the limits of their role;
• follow the service user’s care plan;
• follow infection prevention and control procedures;
• obtain and respect consent;
• recognise deterioration and know when urgent escalation is required; and
• understand when assessment or treatment must be undertaken by a healthcare professional.

General leg ulcer awareness training does not by itself authorise a member of staff to undertake wound assessment, dressing changes, compression therapy or another clinical procedure.

11.2 Competency for Clinical or Delegated Tasks

Where a member of staff is required to undertake a wound-related clinical or delegated healthcare task, {{org_field_name}} must ensure before the member of staff undertakes the task independently that:

• the activity is appropriate to the staff member’s role;
• appropriate delegation or authorisation is in place where required;
• the staff member has received task-specific instruction and training;
• the staff member has been assessed as competent by an appropriately qualified and competent person;
• the competency assessment is documented;
• clear care-plan instructions are available;
• the member of staff understands the limits of the task and escalation requirements; and
• arrangements are in place for review of competence.

Competency must be reassessed at an appropriate frequency and whenever there is reason to question competence, a significant change in the procedure or equipment, a prolonged period during which the task has not been performed, an incident or near miss, or a change in the service user’s treatment that requires different knowledge or skills.

Staff must not undertake a task for which they do not feel competent. Any such concern must be reported immediately to the manager so that alternative safe arrangements can be made.

11.3 Training and Competency Records

{{org_field_name}} must maintain records of relevant training, competency assessments, supervision, refresher training and any restrictions placed on an employee’s practice.

Managers must monitor compliance with required training and competency requirements and take prompt action where training has expired, competency has not been demonstrated or concerns about practice have been identified.

12. Record-Keeping and Documentation

12.1 Service User Records

Staff must maintain accurate, complete, legible and contemporaneous records relating to leg ulcer prevention and care.

Where relevant to the care provided by {{org_field_name}}, records must include:

• relevant risk assessments;
• skin integrity observations;
• identified wounds or ulcers;
• care and treatment provided;
• the date and time care was provided;
• the identity of the staff member providing the care;
• the service user’s response to treatment or intervention;
• pain or other symptoms reported;
• significant changes or deterioration;
• concerns identified;
• treatment refused or not completed and the reason where known;
• referrals and escalations;
• advice or instructions received from healthcare professionals;
• decisions made concerning the person’s care;
• changes to the care plan;
• consent and relevant mental capacity information where applicable; and
• incidents, accidents or other significant events associated with the person’s leg ulcer care.

Records must be completed as soon as reasonably practicable after the event and must not be falsified, retrospectively altered without appropriate identification, or completed in a manner that obscures the original record.

12.2 Professional Instructions and Changes to Treatment

Instructions received from a healthcare professional that affect care delivered by {{org_field_name}} must be documented accurately and communicated promptly to staff who need the information.

Where an instruction changes the intervention that domiciliary care staff are expected to provide, the care plan must be updated before the revised intervention is undertaken wherever reasonably practicable.

Staff must not rely solely upon an informal verbal message from a relative or another person to make a significant change to clinical wound treatment. Where necessary, the instruction must be verified with the responsible healthcare professional.

12.3 Confidentiality and Secure Storage

Service user records, including wound photographs, constitute confidential personal information and must be handled in accordance with applicable data protection legislation and the organisation’s information governance requirements.

Records must:

• be securely stored;
• only be accessed by authorised persons;
• only be shared where there is a lawful basis to do so;
• be protected from unauthorised alteration, disclosure, loss or destruction; and
• be retained and disposed of in accordance with the organisation’s records management requirements.

Personal devices must not be used to create, store or transmit photographs of wounds or other confidential care information unless specifically authorised under an organisational system that meets the required information security standards.

13. Quality Assurance and Continuous Improvement

13.1 Audits and Reviews

We conduct regular audits to evaluate:

• Compliance with care plans and protocols.
• Wound healing outcomes.
• Staff training and competency levels.

13.2 Feedback and Improvement

Service user feedback informs continuous improvement, ensuring care remains person-centred, effective, and responsive to individual needs.

14. Legal and Regulatory Compliance and Policy Review

14.1 Legal and Regulatory Framework

This policy must be implemented in accordance with applicable legislation, regulatory requirements and current national guidance, including:

• Health and Social Care Act 2008;
• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as amended, including:
  • Regulation 9 – Person-centred care;
  • Regulation 11 – Need for consent;
  • Regulation 12 – Safe care and treatment;
  • Regulation 17 – Good governance; and
  • Regulation 18 – Staffing;
• Mental Capacity Act 2005;
• Data Protection Act 2018 and UK data protection requirements;
• applicable Care Quality Commission guidance;
• applicable infection prevention and control requirements; and
• current nationally recognised clinical guidance relevant to the safe management of leg ulcers, including applicable NICE guidance.

Where there is a conflict between this policy and a legal, regulatory or mandatory professional requirement, the legal, regulatory or mandatory professional requirement takes precedence and the matter must be referred to the Registered Manager for immediate review.

14.2 Policy Review

This policy must be reviewed at planned intervals and earlier where necessary following:

• a relevant change in legislation or regulation;
• a material change in CQC requirements or guidance;
• a significant change in nationally recognised clinical guidance affecting care provided by the service;
• a serious incident, recurring incident or identified risk relating to leg ulcer care;
• an audit identifying a significant deficiency;
• a change in the range of wound-related activities undertaken by the service; or
• evidence that the policy is no longer effective in supporting safe care.

The Registered Manager is responsible for ensuring that changes affecting staff practice are communicated to relevant staff and that associated care plans, procedures, training and competency requirements are reviewed where necessary.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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