DCW102-Leg Ulcer Management and Prevention Policy
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Registration Number: {{org_field_registration_no}}
Leg Ulcer Management and Prevention Policy
1. Purpose
The purpose of this policy is to ensure that {{org_field_name}} provides effective, evidence-based leg ulcer management and prevention for service users. Leg ulcers are chronic wounds that require specialist care to prevent infection, promote healing, and reduce recurrence. This policy supports compliance with the Regulation and Inspection of Social Care (Wales) Act 2016; the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017 (as amended); and the Welsh Government statutory guidance for care home and domiciliary support service providers (last updated 27 March 2024). It also supports meeting Care Inspectorate Wales (CIW) expectations within the CIW inspection framework (May 2024) and the inspection ratings requirements introduced under the Regulated Services (Inspection Ratings) (Wales) Regulations 2025. Where healthcare activities are delegated to social care staff, this policy must be implemented alongside the All Wales Guidelines for Delegation (Social Care Wales / HEIW) and any relevant professional standards and local NHS wound care pathways.
Leg ulcers can significantly impact an individual’s mobility, quality of life, and overall well-being. This policy ensures that care staff identify risks early, implement appropriate preventative measures, and manage ulcers efficiently in collaboration with healthcare professionals.
2. Scope
This policy applies to:
- All care staff, including support workers, nurses, and managers, who assist with leg ulcer prevention and care.
- Service users at risk of developing leg ulcers or those currently receiving treatment.
- Healthcare professionals, including district nurses and tissue viability specialists, who collaborate in leg ulcer care.
It covers:
- Risk assessment and early identification of leg ulcers.
- Preventative measures to reduce ulcer development.
- Best practices in wound care and dressing application.
- Infection control and hygiene procedures.
- Coordination with healthcare professionals.
- Staff training and competency in leg ulcer care.
In a domiciliary support service, staff must only undertake leg-ulcer related tasks that are (a) within their role, training and assessed competence, and (b) clearly recorded in the person’s personal plan/care plan. Clinical wound assessment, diagnosis, initiation of treatment, prescribing, and determining dressing or compression regimes remain the responsibility of an appropriate health professional. Where a health professional delegates a specific healthcare activity (for example, applying a specified dressing or assisting with compression hosiery as instructed), delegation must follow the All Wales Guidelines for Delegation and be supported by written instructions, training, competency assessment, supervision, and ongoing review.
3. Principles of Leg Ulcer Management and Prevention
3.1 Rights, consent, capacity and dignity
{{org_field_name}} will deliver leg ulcer prevention and management using a rights-based approach, treating each person with dignity and respect and involving them (and, where appropriate, their representative) in decisions about their care and support.
Consent: Staff must obtain and record the individual’s informed consent before providing any leg ulcer related care or support (including skin inspection, dressing support, hosiery/compression support, repositioning support and photography where used).
Capacity: Where there is reason to believe an individual may lack capacity to make a specific decision about their leg ulcer care, a decision-specific capacity assessment must be completed and recorded in line with the Mental Capacity Act 2005. If the person lacks capacity, any intervention must be in their best interests and be the least restrictive option available.
Privacy and dignity: Leg ulcer care (including dressing support) must be provided in a private, dignified manner in line with the person’s preferences recorded in their personal plan.
Information and education about leg ulcer care will be provided in a format and language the person can understand (including meeting communication needs and, where applicable, Welsh language needs).
3.2 Risk Assessment and Early Identification
Early identification of risk factors is essential to prevent the development of leg ulcers. Care staff must conduct regular skin and vascular assessments for service users who are at higher risk, including those with: Poor circulation (venous or arterial disease). Diabetes, which increases the risk of ulcers and slow healing. Limited mobility or prolonged periods of sitting/bed rest. History of deep vein thrombosis (DVT) or blood clots. Obesity, which can impact circulation. Skin conditions such as eczema, dermatitis, or cellulitis.
Each service user must undergo a leg ulcer risk assessment as part of their initial care plan. If a service user has existing wounds or venous insufficiency, a detailed wound care plan must be implemented in collaboration with a district nurse or tissue viability specialist.
The leg ulcer risk assessment and the leg ulcer care plan must be reviewed and updated whenever there is a significant change, including: new skin breakdown, increased pain, swelling, change in mobility, new diabetes or vascular diagnosis, repeated infection, hospital admission or discharge, a change in prescribed treatment, or where the personal plan is not achieving the person’s desired outcomes.
Staff must escalate immediately to the responsible health professional and/or GP. Where urgent, staff must contact NHS 111 or 999 (as appropriate) if any of the following occur: rapidly increasing pain; spreading redness, heat or swelling; fever, rigors or suspected sepsis; uncontrolled bleeding; black or necrotic tissue; sudden limb coldness or pallor; suspected loss of circulation; suspected DVT (new unilateral swelling, redness and pain); or sudden deterioration in the wound.
3.3 Preventative Measures for Leg Ulcers
To prevent the development of leg ulcers, {{org_field_name}} follows best practices, including: Encouraging good circulation through gentle movement and leg elevation. Supporting the use of prescribed compression therapy where appropriate. Promoting skin hydration using emollients to prevent dryness and cracking. Ensuring service users wear suitable footwear and clothing to prevent pressure damage. Assisting with healthy lifestyle choices, including smoking cessation and a balanced diet to promote skin integrity.
Care staff must encourage mobility where possible, as prolonged immobility increases the risk of venous stasis and ulcer formation. If a service user has limited mobility, repositioning techniques must be used to reduce pressure on high-risk areas such as the heels and lower legs.
3.4 Best Practices in Leg Ulcer Wound Care
If a service user develops a leg ulcer, care must be evidence-based, person-centred, and delivered in collaboration with healthcare professionals. The following best practices must be followed:
- Accurate wound assessment: Care staff must observe and document the size, depth, colour, and exudate levels of the wound, reporting changes immediately to healthcare professionals.
- Appropriate dressing selection: The choice of dressing is determined by the nurse or clinician, based on the type of ulcer, infection risk, and exudate level. Staff must ensure dressings are applied correctly and changed as instructed.
Staff must only apply or change dressings in accordance with clear written instructions from the responsible health professional (for example, district nurse or tissue viability service) and only where they have been trained and assessed as competent. Any deviation, uncertainty, deterioration, or inability to follow the instructions (for example due to missing supplies) must be escalated before proceeding.
- Compression therapy: If prescribed, compression bandages or stockings must be applied and monitored for effectiveness and comfort. Staff should regularly check for signs of restricted circulation or discomfort.
- Pain management: If a service user experiences pain during dressing changes, staff must document this and liaise with healthcare professionals for appropriate pain relief options.
All leg ulcer observations and any support provided (including dressing support, hosiery/compression support, pain observations, and advice given) must be recorded contemporaneously in the person’s care records/personal plan notes. Records must be accurate, complete and up to date, and available for review by relevant professionals and CIW when required.
3.5 Infection Control and Hygiene Procedures
Infection control is critical in preventing wound deterioration and complications. Staff must follow strict hygiene protocols when providing leg ulcer care, including:
- Hand hygiene: Washing hands thoroughly before and after wound care, using appropriate PPE (gloves and aprons).
- Aseptic technique: Ensuring that wounds are cleaned and dressed using sterile materials to prevent contamination.
- Monitoring for infection: Checking for redness, swelling, heat, pus, foul odour, or increased pain, which may indicate infection. If infection is suspected, staff must immediately escalate the concern to the service user’s nurse or GP.
- Safe disposal of dressings: Used dressings must be disposed of in clinical waste bags, following infection control policies.
- Clinical waste: Where clinical waste is generated in the home, staff must follow {{org_field_name}} clinical waste arrangements (including correct bags/containers, storage, and collection/disposal routes) and record any waste disposal issues or concerns as an incident/concern in line with organisational reporting procedures.
3.6 Coordinating with Healthcare Professionals
Leg ulcer care requires collaborative working with external healthcare providers to ensure the best outcomes for service users. {{org_field_name}} ensures that:
- Referrals are made promptly to district nurses or wound care specialists when leg ulcers are identified.
- Care staff communicate effectively with GPs, pharmacists, and tissue viability nurses about treatment plans.
- Service users receive regular medical reviews to monitor healing progress and adjust treatments as needed.
- Emergency escalation procedures are in place for serious complications, such as severe infections, necrosis, or deterioration in wound condition.
Effective communication with healthcare professionals and family members ensures that service users receive holistic, well-coordinated care.
Where a health professional delegates a healthcare activity, the service must keep a clear record of: the delegated task, written instructions, training/competency sign-off, review date, and who to contact for advice. Information must be shared lawfully and proportionately in line with confidentiality and data protection requirements, and key communications must be documented in the person’s records.
3.7 Staff Training and Competency in Leg Ulcer Care
All care staff providing leg ulcer support must receive training on:
- Recognising the early signs of venous and arterial ulcers.
- Understanding and supporting prescribed treatment plans, including dressings and compression therapy.
- Applying infection prevention measures during wound care.
- Recording and reporting wound observations accurately.
- Supporting service users with pain management, mobility, and circulation improvement.
Training and competency must be role-specific and proportionate to the tasks staff will perform. Staff must not undertake leg ulcer related tasks (including any delegated wound care activity) until they have been trained and assessed as competent. Competency must be re-assessed at intervals based on risk and at least annually, and whenever there is a change in the delegated task, the person’s needs, or where practice concerns are identified. Training, supervision and appraisal arrangements must evidence ongoing competence and safe practice, with records retained.
4. Efficiency in Managing Leg Ulcer Care
To ensure efficient and high-quality care, {{org_field_name}} implements:
- Digital care planning systems, allowing real-time updates on wound care progress and treatment changes.
- Standardised wound assessment tools, ensuring accurate documentation and monitoring.
- Regular quality audits, ensuring compliance with best practice and CIW regulations.
- Close collaboration with district nurses and healthcare teams, ensuring timely intervention.
- Service user education and self-care guidance, promoting active participation in prevention and treatment.
These measures ensure that leg ulcer management is consistent, effective, and person-centred, improving healing outcomes and reducing complications.
The Registered Manager and/or Responsible Individual will ensure an ongoing cycle of monitoring, audit and review for leg ulcer care (for example: record quality, escalation timeliness, training/competency compliance, incidents and complaints themes). Where shortfalls are identified, actions will be taken promptly, outcomes tracked, and learning shared with staff to reduce recurrence.
Where something goes wrong and the person is harmed or there is a significant adverse outcome, {{org_field_name}} will act openly and transparently with the individual and/or their representative. This includes explaining what happened, offering an apology where appropriate, documenting the discussion, and recording actions taken and learning to improve practice.
The service will cooperate with CIW inspections and ensure any inspection ratings are recorded and displayed in line with legal requirements and CIW guidance.
4.1 Safeguarding, incident reporting and notifications
Safeguarding: Any concern that an individual may be experiencing abuse, neglect, improper treatment, or avoidable harm linked to wound care (including missed visits, poor practice, lack of supplies, or failure to escalate deterioration) must be reported immediately in line with {{org_field_name}} Safeguarding Policy and local safeguarding procedures.
Incidents/concerns: Any significant wound deterioration, suspected infection requiring urgent treatment, medication errors affecting wound care, missed/late visits that impact treatment, or equipment failure must be reported as an incident and reviewed to prevent recurrence.
Notifications: Where an event meets the regulated service notification requirements, the service provider will notify CIW and other relevant bodies without delay (normally within 24 hours) in line with statutory guidance and organisational notification procedures.
5. Related Policies
This policy should be read alongside:
- Safe Care and Treatment Policy (DCW11)
- Infection Prevention and Control Policy (DCW17)
- Risk Management and Assessment Policy (DCW18)
- Medication Management and Administration Policy (DCW21)
- Person-Centred Care Policy (DCW07).
6. Policy Review
This policy will be reviewed annually, or sooner if clinical guidelines, CIW regulations, or service needs change.
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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