Annual foot assessment for people with diabetes

We welcome feedback on this policy and the way it operates. We are interested

to know of any possible or actual adverse impact that this policy/procedure may

have on any groups in respect of gender or marital status, race, disability, sexual

orientation, religion or belief, age or other characteristics.

Document No. / Version / Date Approved / Last Review / Review Date / Equality Impact Assessed / Author/Contact Person
2 / n/a / June 2012 / Screened will need partial EIA / MK Diabetes Care
Lead Podiatrist

Approved By:

For use in (clinical area) / General Practice
For use by (staff groups) / All health care professionals trained in foot care NB Annual Foot assessment checks not done by Podiatry team
For use for (patients/staff/public) / People with Diabetes
Document Owner: / MK Diabetes Care,Navdeep Grewal, Podiatry lead for people with diabetes
Document Status: / DRAFT
Document History ---- ,
Version / Date / Author / Reason
1 / October 2008 / Ruth Chilcraft / Improve foot assessments
2 / June 2011 / Ruth Chilcraft / Update foot assessments

1.0 Introduction...... .3

1.1Policy Statement and aim....... ..3

1.2Objectives...... 3

2.0 Scope of document...... 3

3.0 Roles and responsibilities...... 3

4.0 Diabetes Foot Care guideline and emergency pathway...... 3

5.0 Audit and monitoring Criteria...... 4

6.0 Statement of evidence/references...... 6

Harvard Style Reference Example: Standard.

7.0 Equality Impact Assessment...... 6

8.0 Standards for Better Health...... 6

9.0 Implementation and dissemination of document...... 7

10.0 Overall responsibility for the document...... 6

1.0 Introduction

1.1 Policy Statement and aim

All people with diabetes should have their feet assessed by a health care professional trained in foot care on an annual basis

1.2 Objectives

To ensure that all people with diabetes have the correct care and assessment of their feet

2.0 Scope of document

Applies to all services providing care/treatment of people with diabetes in Milton Keynes NB Annual Foot assessment checks not done by Podiatry team

3.0 Roles and responsibilities

Role / Responsibility
MK Diabetes Care / To monitor the guideline's use
MK Diabetes Care &Lead Podiatrist, Diabetes / To disseminate the guideline, advise on it and review the guideline
use
Service managers/senior clinicians / Ensure that all relevant staff are aware of the guideline and receive training necessary to implement it
Practitioners / Work in accordance with the guideline

4.0Foot-care Guideline

All people with Diabetes should have their feet examined annually by a trained health care professional.

  • Inspect the feet for shape, deformity, skin changes and footwear
  • Palpate foot Pulses: Dorsalis pedis, Posterior tibialis (see read codes below)
  • Test sensations with 10g monofilament (see read codes below)
  • Check for general disability, visual impairment

Normal Sensation
(4/6 per foot)
AND
Good Pulses
AND
No previous ulcer
AND
No foot deformity
AND
Normal Vision / Loss of sensation
OR
Absent pulses
OR
Previous vascular surgery
OR
Significant visual impairment
OR
Physical disability
(Eg. Stroke, gross obesity, Breathing difficulties) / Previous ulcer due to neuropathy/
ischaemia
OR
Absent pulses AND Neuropathy
OR
Callus with risk factor:
(Eg. Neuropathy, absent foot pulse, foot deformity)
OR
Previous amputation / Active foot Disease:
Ulceration,
OR
Acute inflammation,
OR
Necrosis
OR
Charcots
OR
Painful neuropathy which is difficult to control
LOW RISK / MODERATE RISK / HIGH RISK / ACTIVE FOOT DISEASE
1.Annual Review
2. Guide to Foot Health leaflet &booklet for self care.
If podiatry input is needed – complete Community Podiatry Referral Form by client or health care professional. / 1. May review sooner
2. Guide to Foot Health leaflet
If Podiatry input is needed - complete
Community Podiatry Referral Form by client
or health care professional. / 1.Regular podiatry for foot care
2.Guide to Foot Health leaflet
Community referral form completed by client
Or health care professional stating reasons for high risk
Tel - 01908 650450 or 01908 650451 / 1.Urgent referral to acute health care podiatry specialist team
2.Apply temporary dressing
-Complete Maple Unit Podiatry Diabetes referral form
-Fax completed referral to:
01908 650461
Clinics run:
Tues,Thurs 9-11.30
Fridays 1.30-3.30
*See emergency care below

4.1Assessment

QOF Codes for Foot Screening DM 29

Foot Screen Codes Term / V2 / CTV3
Diabetes foot screen / 66Aq / XaPQH
Under care of diabetic foot screener / 9NND / XaJO9
Refer to diabetic foot screener / 8H7r / Xa1QS
Peripheral Pulses R- leg / 24E1, 24EF / XE1hO%
Peripheral Pulses L- Leg / 24F1,-24FF / XE1hP%
DNA Diabetes foot screen / 9NZ / XaXHD
Patient unsuitable for foot pulse check / 81B6 / XaWR7
Diabetics foot examination declined / 813W / XaJix
Foot Risk Codes Term
Diabetic foot at low risk
(R & L) / 2G5E, 2G5I / XaIeH, XaIeL
Diabetic foot at moderate risk ( R & L) / 2G5F., 2G5J / XaIeR, XaIeS
Diabetic foot at High Risk
( R & L) / 2G5G., 2G5K / XaIeI, XaIeM
Diabetic foot- Ulcerated
( R & L) / 2G5H., 2G5L / XaIeJ, XaIeK

4.2 Out of hour’s emergency pathway

*OUT OF HOURS EMERGENCY*

(When clinic not open and weekends)

Active foot disease
Foot should be elevated and rested completely
Provide foot ulcer leaflet if required
Sterile dressing:
If dry – NA dressing
If discharging – Heavy foam dressing
If infected – silver/iodine dressing
Antibiotic of choice – Flucloxacillin 500mg QDS 2 weeks
Take swabs from deep wound bed
Orthotist if shoe needed Tel. 660033(Acute Trust)Referral letter required or print off and complete referral form from MKFHT intranet site.

Urgent referral

CRITICAL ISCHAEMIA
  • rest or night pain
  • pale/mottled feet
  • ischaemic ulceration
  • gangrene
TEL 660033
ON CALL SURGEONS / SEVERE INFECTION
  • abscess
  • cellulitis
TEL 660033
ON CALL MEDICS

5.0 Audit and monitoring criteria

Document Audit and Monitoring Table
Monitoring requirements / Compliance with guideline
Monitoring Method: / An audit of the Diabetes NICE guideline compliance will conducted in 2012
be
Monitoring prepared by :- / PN with responsibility for the guideline/ PCT audit facilitator
Monitoring presented to:- / Clinical governance operational group Practice Nurse forum
Frequency of presentation:- / 2012 one-off baseline audit frequency to be determined by level of compliance with guideline

6.0 Statement of evidence/references and other associated documents

Reference: National Institute of Clinical Excellence:CG10 Type2 diabetes - foot care. January 2004

7.0 Equality Impact Assessment

This document has been screened for its equality impact; it does not differentiate between individuals or groups on the grounds of age, ethnicity, religious beliefs, gender, disability or sexual orientation. It will therefore need only a partial EIA.

8.0 Standards for Better Health

This document is relevant to the following HCC domains:

Domain / Definition/Evidence
Safety / C3 Using NICE evidence
Clinical and Cost Effectiveness / C5a: Using NICE evidence

9.0 Implementation and dissemination of document

The document will be placed on the MK Diabetes Care website. Health professionals will be informed of the document at relevant educational meetings.

10.0 Overall responsibility for the document

MK Diabetes Care / Podiatry Dept MKPCT