T he Diabe tic F oot Sc r e e n and Manage me nt F oundation - - PowerPoint PPT Presentation

T he Diabe tic F

• ot Sc r

e e n and Manage me nt

F

• undation Se r

ie s of Module s for Pr imar y Car e

Anita Murra y - Se nio r Po dia trist Dia b e te s, SCH

L e a rning Outc ome s

 K

no wle dg e o f the Mo de l o f Ca re F

• r T

he Dia b e tic F

• o t

 Unde rsta nd ho w to do the Dia b e tic F

• o t Sc re e n

 Ho w to lo o k o ut fo r Co mmo n Na il a nd F

• o t c o nditio ns tha t inc re a se a mputa tio n risk

 Ho w to a c c e ss the F

• o t

Pro te c tio n T e a m

How Dia be te s a ffe c ts the fe e t

T he Sta irwa y to Amputa tio n, 2010

Mode l of Ca re F

• r T

he Dia be tic F

• ot

(Na tiona l Dia be te s Prog ra mme 2011)

 Aims a t hig hlig hting fo o t c o mplic a tio ns a sso c ia te d with Dia b e te s with the a im o f

pre ve nting ulc e ra tio n a nd L imb L

• ss

 All pe o ple living with dia b e te s sho uld ha ve the ir fe e t a sse sse d a t le a st a nnua lly a nd the ir

fe e t will b e g ive n a risk c la ssific a tio n

 L

• w Risk

 Mo de ra te Risk  Hig h Risk  Ac tive fo o t dise a se

Dia be tic F

• ot Sc re e n

 Asse ssme nt o f the dia b e tic fo o t sho uld inc lude inspe c tio n, pa lpa tio n & se nso ry te sting .  Re c o rd sig ns o f ne uro pa thy, isc he mia , de fo rmity, c a llus, swe lling , ulc e ra tio n, infe c tio n o r

ne c ro sis sho uld b e re c o rde d

 E

a c h pa tie nt sho uld b e g ive n a RI SK ST AT US a nd re fe rre d o n if ne c e ssa ry SCH Re c o rds Audit : April 2016 72% Aug ust 2016: 88%

T e sts – Va sc ula r e xa m

Do rsa lis Pe dis T e st

T e sts – Va sc ula r e xa m

Po ste rio r tib ia l a rte ry Pa lpa te

T e sts – Va sc ula r e xa m

 I

f pulse s no t pa lpa b le use do pple r

 Mo no pha sic  Bipha sic  T

ripha sic

Sig ns a nd Symptoms of Va sc ula r c ompromise d foot

 Pa in – Cla udic a tio n, nig ht c ra mps, re st pa in  Pa llo r - white  Pulse le ssne ss  Pa ra the sia  Pa ra lysis  Pe rshing c o ld

T e sts – Ne urolog ic a l e xa m

T uning F

• rk

 T

• b e te ste d initia lly o n wrist to

de mo nstra te se nsa tio n

 Sho uld b e use d o n a pro mine nc e i.e . 1st

Me ta ta rsa l he a d

 F

irst sta g e s o n ne uro pa thy

T e sts – Ne urolog ic a l e xa m

10g mo no fila me nt Site s

Obse rva tions of a ne uropa thic foot

 Dysfunc tio n o f mo to r, se nso ry a nd a uto no mic ne rve s  F

• o t is wa rm, we ll pe rfuse d with b o unding pulse s

Wha t c o uld it lo o k like ?

 Cla wing o f the to e s  Pro mine nt me ta ta rsa l he a ds  Po ssib le ro c ke r b o tto m de fo rmity (c ha rc o t)  Hig h a rc h  Ca llus fo rma tio n

F

• ot De formitie s
• Bunio n jo ints
• Ha mme r to e s
• Pro mine nt Me ta ta rsa l He a ds

Unc ove ring ulc e rs

• Ulc e r unde rlying c a llus

Ulc e r po st de b ride me nt L

• o ks c a n b e de c e iving ...

Sta tus

Pulse s Vibr ation Se nsation Histor y of ulc e r ation F

• ot

De for mity Visual Impair me nt

L

• w Risk

All no rma l No ne Mo de ra te Risk One o f a b o ve a b no rma l No ne ma yb e Hig h Risk All c o mpro mise d

Always

ma yb e ma yb e

Re vie w proc e ss

Initia l Dia be tic F

• ot Ulc e r Ma na g e me nt

 Be g ins with a c o mpre he nsive histo ry a nd physic a l  T

ho ro ug h wo und a sse ssme nt, tre a tme nt a nd re fe rra l inc luding :

• •Ma na g e me nt o f pe riphe ra l a rte ria l dise a se (PAD) – re fe rra l to Va sc ula r te a m?
• •I

nfe c tio n c o ntro l a nd ma na g e me nt - e g . Culture a nd se nsitivity, Antib io tic c o ve r?

• •De b ride me nt a nd Off-lo a ding ne c e ssa ry * re fe rra l to Po dia try*
• •Ma inta ining a mo ist wo und e nviro nme nt – e g . ste rile dry dre ssing a nd re fe r to Po dia try

***T ime ly wo und he a ling is le ss like ly witho ut c o mpre he nsive ma na g e me nt, inc luding o ff- lo a ding , Va sc ula r input a nd mo nito ring fo r infe c tio n***

Re fe rra l to L

• c a l Podia try Se rvic e s



All re fe rra ls will b e tria g e d b y the Po dia trist o r a me mb e r o f the fo o t pro te c tio n te a m. T he y will b e prio ritise d a s the fo llo wing :



Ac tive diabe tic foot ulc e r (non infe c te d):



1 da y o r ne xt wo rking da y in SCH



Infe c te d diabe tic foot ulc e r with spre ading c e llulitis, Suspe c te d Oste omye litis:



Atte nd E D a t SVUH fo r a dmissio n o n the Dia b e tic F

• o t Ca re Pa thwa y



At Risk Diabe tic F

• ot Classific ation:



T e le pho ne re vie w within 2 we e ks, a ppo intme nt da te to b e a g re e d fo r SCH o r Prima ry Ca re Ce ntre



Re que st for Clarific ation of Risk Status/ :



T e le pho ne re vie w within 2 we e ks, a ppo intme nt to b e ma de if re q uire d a t SCH o r Prima ry Ca re Ce ntre

Podia try Se rvic e De ve lopme nt Upda te

 Dia b e tic F

• o t Ca re pa thwa y, SVUH

 Inte g ra te d pa thwa y c ha mpio ne d b y E

d e l K e lle g he r, Clinic a l Spe c ia list Po d ia trist in c o njunc tio n with Va sc ula r, E nd o c rino lo g y, Opa te te a m, In pa tie nt unit a nd Mic ro b io lo g y.

 Re d uc e d ho spita l d ia b e te s re la te d a mputa tio n ra te s a nd c o st to pa tie nts q ua lity o f life a nd to ho spita l

b e d sta ys

 No mina te d fo r Na tio na l Awa rd fo r c linic a l e xc e lle nc e

 At Risk F

• o t Offlo a ding a nd Ortho se s Clinic

 Ne uro pa thic Ulc e r Pre ve ntio n Ca re pa thwa y, SCH a nd Prima ry Ca re  Pa tie nt c e ntre d se rvic e a c ro ss prima ry a nd se c o nd a ry c a re se tting .  Po d ia try le a d Ortho se s a nd fo o twe a r Se rvic e (inc lud ing inte g ra te d c linic with Ortho tist)  so fa r re d uc ing c o st o f o rtho se s b y 63% a nd wa iting time s fo r o rtho se s fro m 9 mo nths to six we e ks.

DE MONST RAT ION

Group Work

Ca se Ba se d le a rning a nd g ro up fe e db a c k

 Ho w wo uld yo u de sc rib e the wo und pre se nta tio n?  Ho w wo uld yo u a sse ss this? (Ob se rva tio ns, histo ry te sts)  Wha t a b o ut ma na g e me nt? (I

mme dia te Ac tio ns a nd re fe rra ls)