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Page last updated:
8th June 2023
8th June 2023
Take our expert quiz to test your knowledge on scenarios where people with a leg or foot condition might be a risk of being harmed and learn what the correct course of action is to avoid this.
This quiz has been written by clinical experts and is designed for anyone who treats patients with a leg or foot condition and wants to test and improve their knowledge on how to deliver the safest care.
Where's the harm in that?
Can you spot the hidden harm in leg and foot care?
Get started
Question 01/12
Can compression therapy be used on a patient who’s had a Deep vein thrombosis (DVT)?
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Answer 01/12
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Yes, compression therapy can be used on a patient who’s had a deep vein thrombosis (DVT).
It is a common myth that compression cannot be used in patients with acute DVT. There is no evidence that compression therapy increases risk of pulmonary embolism. In fact there is evidence that it helps reduce symptoms of post thrombotic syndrome. Obviously the DVT needs appropriate medical management BUT if your patient is experiencing conditions where compression therapy may be beneficial (venous leg ulcer, oedema, venous skin changes) it can be safely used.
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Question 02/12
Can you use strong compression on a patient who’s got congestive cardiac failure?
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Answer 02/12
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Yes, you can use strong compression on patients who have congestive cardiac failure.
Many patients with heart failure will have lower limb oedema and it is important that this is appropriately management with compression therapy. The risk of overloading the heart in patients with stable heart failure is extremely low. However caution is needed if patients are experiencing episodes of acute decompensated heart failure.
See the Wounds UK Best Practice Statement for more information.
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Question 03/12
Do patients with a neuropathic foot wound always require offloading?
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Answer 03/12
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No, patients with a neuropathic foot wound don’t always require offloading.
The main cause of any neuropathic foot wound is pressure, either from direct pressure, sheer or friction. This is commonly caused by footwear. Every patient with a neuropathic foot wound needs a footwear assessment and detailed consideration of whether the patient needs additional offloading devices.
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Question 04/12
A patient’s wound has not healed within 2 weeks. Is this normal?
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Answer 04/12
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No, it is not normal. A patient’s wound should have healed within 2 weeks.
Non-healing is not normal. If a patient has had a wound for more than 2 weeks, we need to consider what the underlying cause of the wound is (e.g. venous hypertension, peripheral arterial disease, neuropathy, pressure). We also need to ensure effective evidence-based therapy is in place. In addition, we need to think about what the individual patient risk factors are which might make healing more difficult, and consider how we can manage these better.
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Question 05/12
A patient has to wait 6 weeks to have an ABPI (Ankle Brachial Pressure Index). Is this appropriate?
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Answer 05/12
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No, it is never appropriate for a patient to wait 6 weeks to have an ABPI
Patients with lower limb wounds that are not healed by 2 weeks need full holistic assessment that includes an ABPI to identify the underlying cause and their suitability for evidence-based therapies. The ABPI is often the key to the door for strong compression therapy. Waiting 6 weeks for an ABPI is simply unacceptable.
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Question 06/12
A patient’s foot ulcer is showing clinical signs of infection and they are prescribed a seven-day course of antibiotics. On review, all the surrounding redness has resolved, and the ulcer has reduced in size.
Do you:
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Answer 06/12
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B Yes, discontinue antibiotic treatment and continue to closely monitor the wound.
If all the clinical signs of infection have resolved then the patient does not need further antibiotics. The wound should be closely monitored at each dressing change, ensuring the wound and the surrounding skin is appropriately cleansed and the wound bed is effectively debrided. If the wound deteriorates, and there is a recurrence of signs of infection, further antibiotics may be required. However, continuing antibiotics in the absence of infection can increase the risk of antibiotic resistance.
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Question 07/12
Your patient has been wearing compression stockings for a year, a recent ABPI has been taken and is within normal limits. They are due another pair of stockings.
Do you:
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Answer 07/12
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B Yes, you should ask your patient to come in so you can measure their legs before issuing a prescription?
Your patient’s legs may have changed shape or size since they were originally prescribed stockings. A stocking prescription based on leg measurements from over a year ago might reduce the effectiveness of the compression therapy and could cause harm through sub-optimal compression or lack of use because of discomfort.
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Question 08/12
Your patient has recently changed from circular knit to flat knit stockings. They contact you to say their legs have changed shape. They are due for a review in 3 months.
Do you:
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Answer 08/12
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A Yes, ask them to make an appointment to see you for an immediate assessment of their legs.
Any change in leg shape should be assessed as soon as possible. It could be a sign that the new stockings are not working or are causing harm due to a poor fit.
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Question 09/12
A patient regularly misses their weekly appointment to have their leg ulcer assessed and dressings changed.
Do you:
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Answer 09/12
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B Yes, ask your patient about their lifestyle, work or caring responsibilities to understand why they are unable to attend every appointment
It’s important to understand why a patient is unable to attend appointments and, where possible, to offer alternatives that better fit the patient’s lifestyle. They may also not understand the rationale for the treatment plan; this needs to be discussed and any gaps identified so that a joint treatment plan can be truly developed.
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Question 10/12
A patient has significant pain with a particular dressing. They were told by the nurse to expect it, that this is normal and that dressing is necessary.
Do you:
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Answer 10/12
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A. Yes, ask them about their pain and look for an alternative dressing.
When pain is cyclical and frequent, there is a high risk of this being exacerbated and changing into anticipatory pain or neuropathic pain. This is very detrimental to the patient. It is essential that if the dressing gives pain, that the patient is encouraged to tell the clinician and you look for an alternative.
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Question 11/12
A patient says they are unhappy about the compression therapy they are receiving and that they do not understand why they need this.
Do you:
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Answer 11/12
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B. Yes, ask your patient about what their knowledge of compression is and explore their understanding and belief and what they think is best for them and their leg.
The choice may be impacting on their lifestyle, pain, discomfort, health and ultimately healing. If the leg ulcer is not healing, then it is critical to change or adjust the compression therapy. There is no reason why the patient will believe this is a benefit if they are not seeing improvements in the healing or pain reduction. Provide them with information on the various compression treatments and the pros and cons of each. Decide what can be trialled and how they can be jointly evaluated.
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Question 12/12
You have been seeing a patient for 4 weeks now and the leg ulcer doesn’t seem to be making very much progress.
Do you:
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Answer 12/12
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B. Yes, you should make an immediate referral to a specialist service such as vascular for an assessment
With the implementation of evidence-based treatment, good wound healing should be evident at 4 weeks. It is important that the patient is referred to a specialist service as soon as possibly to determine whether advanced interventions are required (such as venous ablation). This will prevent wound deterioration and patient harm.
Finish
Final score /12
This score indicates low awareness of harm and how to prevent it.
Next steps: read our resources for healthcare professionals to get expert advice on best practice treatment of people with a leg or foot condition.
Final score /12
This score indicates a fair awareness of harm and how to prevent it.
Next steps: read our resources for healthcare professionals to get expert advice on best practice treatment of people with a leg or foot condition.
Final score /12
This score indicates a good awareness of harm and how to prevent it.
Next steps: read and share our Ten Point Plan to Tackle Harm
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