Educational Resources & Summary€¦ · International Working Group on the Diabetic Foot UK –...
Transcript of Educational Resources & Summary€¦ · International Working Group on the Diabetic Foot UK –...
Educational Resources & Summary
Wendy McInnes; Vascular Nurse Practitioner
The Lyell McEwin Hospital, Adelaide, South Australia
wendy.mcinnes@sa,gov.au 0447 051 036
Diabetes:- the Global Epidemic 2015 415 million adults world wide with diabetes
By 2040 estimated 642 million
Prevalence in 30 years has increased from 4.7 to now 8.5%
1 in 4 people with diabetes is at risk of ulceration
Commonwealth of Australia (2011) National Evidence based Guideline - Prevention, Identification and Management of Foot Complications in Diabetes International Diabetes Federation (2015) IDF Diabetes Atlas; 7th Edition, International Diabetes Federation Diabetic Foot Problems – NICE Pathway (2011) http://publications.nice.org.uk/diabetic-foot-problems-cg119/guidance
Australia
Even minor injuries caused by a small cut, bruise or a blister can develop into a diabetic foot ulcer
Every three hours in Australia, a person with diabetes has a lower limb removed as a direct result of diabetes-related foot disease.
50% of these will go on to live less than five years
With best practice treatment, and ongoing management, 80% of amputations are preventable.
https://www.diabeticfootaustralia.org/
Previous amputation
Past foot ulcer history
Peripheral neuropathy
Foot deformity
Peripheral vascular disease
Visual impairment
Diabetic nephropathy
Poor glycaemic control
Smoking
Diabetic Foot: Risk Factors
Clinical Practice Guidelines; Management of Type II Diabetes – 4th edition –– Malaysia - http://www.docstoc.com/docs/80288898/Malaysian-Diabetes-Association
World Wide: Guidelines/Programs International Working Group on the Diabetic Foot
UK – NICE – Clinical guidelines / pathways
SIGN – Clinical Guideline 116
Australia – Prevention, Identification and Management
of foot complications in diabetes & Diabetic Foot Australia
US – LEAP
Clinical Practice Guidelines - Malaysia
Aim – prevent minor/major amputation
Commonwealth of Australia (2011) National Evidence based Guideline - Prevention, Identification and Management of Foot Complications in Diabetes International Working group on the Diabetic Foot (2011) http://www.iwgdf.org/index.php?option=com_content&task=view&id=16&Itemid=26 Diabetic Foot Problems – NICE Pathway (2011) http://publications.nice.org.uk/diabetic-foot-problems-cg119/guidance
Clinical Guidelines
• Prevention and management
• Inpatient management
Other resources
• Patients
• Health Professionals
– Algorithms
– Patient education framework
National Institute for Clinical Evidence (NICE)
Scottish Collegiate Guidelines Network (SIGN)
National Institute for Clinical Evidence http://www.nice.org.uk/
Scottish Collegiate Guidelines Network http://www.sign.ac.uk/guidelines/fulltext/116/index.html
US : 5 Step Lower Extremity
Amputation Prevention (LEAP) Program
Annual Foot Screening
• Monofiliment to screen those at risk
• Those at risk to be seen 4 times per year to check feet and footwear
Patient Education
• Patient assumes personal responsibility – partner with health care team
Daily Self Inspection
• Early detection of injury, nail problems
Footwear Selection
• Correct fit for length, width, box depth
Management of Simple Foot Problems
• Autonomic neuropathy, cracks, dry skin
• Identify problems early and report
Free resources available on the site for patients and health care professionals
US Department of Health and Human Services - Health Resources and service Administration
http://www.hrsa.gov/hansensdisease/leap
Advise the patient to
Check their feet every day
Be aware of loss of sensation
Look for changes in the shape of their foot
Not use corn removing plasters or blades
Know how to look after their toe nails
Wear shoes that fit properly
Maintain good blood glucose control
Attend their annual foot review
Putting Feet First Campaign – Diabetes UK
Putting Feet First – Diabetes UK - http://www.diabetes.org.uk/Documents/Professionals/Education%20and%20skills/Footcare-pathway.0212.pdf
Risk status
should be
Documented
& patient
informed
Diabetes Foot Screening
Foot Risk Awareness & Management Education (FRAME)
Free e-learning modules
http://www.diabetesframe.org/
Diabetic foot screening
Assess
– Sensory neuropathy
– Motor neuropathy
– Vibration loss
– Pedal Pulses
– Nail/Skin Integrity
– Structural Foot Deformities
– Footwear & Offloading
– Range of Motion
– Foot care
Follow up based on risk category
Treatment Plan regime
International Diabetes Federation
Resources and information for clinicians and the public
– Patients
• Caring for you’re feet – prevention & checklists
• Where to get help & find a clinic
• Joining a clinical trial
– Clinicians
• Guidelines
• Clinical Trials
• Latest Research
https://www.diabeticfootaustralia
Australian Guidelines
Foot Protection Program
• Aim to prevent foot complications in people with diabetes and includes the following components
• Podiatry
• Hygiene maintenance – advice to inspect and wash feet daily
• Appropriate footwear and hosiery
• Protective shoes – avoid constrictive footwear
• Clinic contact initiated by patient if concerned
National Evidence based Guideline for the Prevention, 2011 “Identification and Management of Foot Complications in Diabetes” (Part of the Guidelines on Management of Type II Diabetes)
Melbourne Australia ; https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/diabetes_foot_full_guideline_23062011.pdf
Commenced 1996 – improve outcomes
Objectives
– Multidisciplinary consensus documents
– Management and prevention
– Cost effective quality health care
– Adapt for local use
International Working Group
on the Diabetic Foot
Good Diabetic Control
• Patient self monitoring
• Recognising early warning signs of problem
• Seek help early
• Sick day management
• 3 monthly HbA1c <6.5mmHg
Evaluation and treatment of peripheral artery disease
Lifestyle/ Risk Factor modification
• Hypertension
• Cholesterol
• Smoking
Pharmacological interventions
Psychosocial issues
Education
• Risk awareness – complications – daily inspection
• Infection awareness – reduced signs of infection/inflammation/ pain
Summary of World Wide Prevention Strategies
Commonwealth of Australia (2011) National Evidence based Guideline - Prevention, Identification and Management of Foot Complications in Diabetes International Working group on the Diabetic Foot (2011) http://www.iwgdf.org/index.php?option=com_content&task=view&id=16&Itemid=26 Diabetic Foot Problems – NICE Pathway (2011) http://publications.nice.org.uk/diabetic-foot-problems-cg119/guidance Assessment & Management of foot ulcers for people with diabetes – Best Practice Guidelines – Ontario – Canada http://www.rnao.org/Storage/11/536_BPG_Assessment_Foot_Ulcer.pdf
Regular podiatry
• Early, regular assessment for neuropathy/ vascular status
• Early treatment for issues - debride callous/ wound
• Offloading/ redistribution of pressure
• Assess & address biomechanical issues if possible – referral
• Patient education / self management Daily foot inspection
Include areas between toes
• If eyesight poor or cannot do it – family, friend or carer
• Act on problems early – friction, shear, callous, cracks, blisters
Daily hygiene
• Dry between toes
• Ensure temperature of water not too hot – sensory neuropathy
• Moisturise at least daily
Footwear
• Ensure correct fit
• Inspect daily
• Orthotics/ offload/redistribute pressure
Injury Prevention
• Care when mobilising
• Never wear footwear that has caused pressure/friction/shear/ callous
Summary of World Wide Prevention Strategies
High risk patients require inter-disciplinary care
Refer to Multi-D High Risk Diabetic Foot Clinics if
• Deep ulcers – probe to tendon, joint or bone
• Ulcers not reducing in size after 4 weeks despite appropriate treatment
• Absent pulses/ limb threatening
• Ascending cellulitis and suspected Charcot neuropathy
• Pain in previously insensate foot
Summary of World Wide Prevention Strategies
Commonwealth of Australia (2011) National Evidence based Guideline - Prevention, Identification and Management of Foot Complications in Diabetes International Working group on the Diabetic Foot (2011) http://www.iwgdf.org/index.php?option=com_content&task=view&id=16&Itemid=26 Diabetic Foot Problems – NICE Pathway (2011) http://publications.nice.org.uk/diabetic-foot-problems-cg119/guidance Assessment & Management of foot ulcers for people with diabetes – Best Practice Guidelines – Ontario – canada http://www.rnao.org/Storage/11/536_BPG_Assessment_Foot_Ulcer.pdf