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National Diabetes Audit - Foot Examination

National Diabetes Audit - Foot Examination. Keith Hilston – Podiatry Diabetes Lead, May 2013. Content. Why foot examination is important National / Local picture Foot screening (examination) Outcomes. NDA Foot Exam Why important – risk classification.

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National Diabetes Audit - Foot Examination

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  1. National Diabetes Audit - Foot Examination Keith Hilston – Podiatry Diabetes Lead, May 2013

  2. Content • Why foot examination is important • National / Local picture • Foot screening (examination) • Outcomes

  3. NDA Foot Exam Why important – risk classification

  4. NDA Foot Exam Why important – Quality of Life

  5. NDA Foot Exam Why important – Mortality

  6. NDA Foot Exam Why important – Cost

  7. NDA Foot Exam National Update • Halving amputation rates in 5 years • Develop Quality Improvement Framework • Audit and publish local outcome data annually

  8. NDA Foot Exam Locality Update • Indicator NM12 DM10 • The percentage of patients with diabetes with a record of testing of foot sensation using a 10g monofilament or vibration (using biothesiometer or calibrated tuning fork), within the preceding 15 months • Indicator NM13 DM9 now DM29 • The percentage of patients with diabetes with a record of a foot examination and risk classification: 1) low risk (normal sensation, palpable pulses), 2) increased risk (neuropathy or absent pulses), 3) high risk (neuropathy or absent pulses plus deformity or skin changes or previous ulcer) or 4) ulcerated foot within the preceding 15 months

  9. NDA Foot Exam Locality Update

  10. NDA Foot Exam Locality Update

  11. NDA Foot Exam Locality Update

  12. NDA Foot Exam Foot Screening • That HCP should have the skills necessary to: • a. identify the presence of sensory neuropathy (loss of ability to feel monofilament, vibration or sharp touch) and/or the abnormal build up of callus • b. identify when the arterial supply to the foot is reduced (absent foot pulses, signs of tissue ischaemia, symptoms of intermittent claudication) • c. identify deformities or problems of the foot (including bony deformities, dry skin, fungal infection) that may put it at risk • d. identify other factors that may put the foot at risk (which may include reduced capacity for self-care, impaired renal function, poor glycaemic control, cardiovascular and cerebrovascular disease). • Putting Feet First: national minimum skills framework: March 2011

  13. NDA Foot Exam a. sensory neuropathy • Place the calibrated tuning fork on the inter phalangeal joint of the first toe. • Ask the patient to tell you when vibration can no longer be felt and measure the point on the scale when this happens. • Neuropathy exists where the point on the scale is below 4. A result of 4 and above indicates that neuropathy is not present.

  14. NDA Foot Exam a. sensory neuropathy Test five sites on each foot. If the patient responds yes to the application of pressure then mark + ve If the patient responds no to the application of pressure then mark – ve. A score of 6 and below = neuropathy. Score 7 and above=no neuropathy.

  15. NDA Foot Exam a. sensory neuropathy

  16. Foot Screening Neuropathy • Sensory neuropathy • Increased susceptibility to • foot ulceration • Motor neuropathy • Increased prominence • metatarsal heads • Digital clawing • Loss anterior tibial muscle • group power (foot drop) • Autonomic neuropathy • A-V shunting • Reduced sweating • Temperature gradient • Rubor • Diabetic Neuropathic Pain • Possible prevalence 16.2% • Of these 12.5% may not report • symptoms to HCP (Daousi 2004)

  17. NDA Foot Exam b. reduced arterial supply

  18. NDA Foot Exam c. identify deformities

  19. NDA Foot Exam c. identify deformities

  20. NDA Foot Exam d. other risk factors • reduced capacity for self-care • cardiovascular disease • impaired renal function • poor glycaemic control

  21. Basic patient education A neuropathy B vascular C deformity D other Urgent referral to Podiatry Refer to Podiatry Inform patient risk rating Refer to Podiatry Education

  22. NDA Foot Exam Why it is important

  23. NDA Outcomes Minor Amputations

  24. Diabetes Footcare Profile

  25. NDA Outcomes Major Amputations

  26. Diabetes Footcare Profile

  27. Diabetes Footcare Profile

  28. Diabetes Footcare Profile

  29. NDA to include Diabetes footcare • The National Diabetes Audit is expanding to cover: • Diabetes footcare • This audit will cover the structures, processes and outcomes of foot care services for people with diabetes. The audit is currently being developed and piloted by NHS Diabetes and is expected to be handed over to the NDA for national roll out in 2013.

  30. NDA to include Diabetes footcare 14 Pilot sites, >490 new ulcers (baseline data only)

  31. Diabetes Footcare Website • http://www.berkshirewest.nhs.uk/page_sa.asp?fldKey=310 • Diabetic Foot Care Pathway • Referral form • Emergency contact details • Patient leaflets

  32. Foot Screening Training AIM To have an understanding of how to carry out an annual foot assessment for patients with diabetes. OBJECTIVES To understand and gain confidence with assessment tools. To identify neuropathy, ischemia and foot deformity. To understand the process of annual review and when to refer on for Podiatry treatment and education.

  33. QUESTIONS?

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