Title: Diabetic Foot Problems
1Diabetic Foot Problems
Implementing NICE guidance
March 2011
NICE clinical guideline 119
2What this presentation covers
- Background
- Epidemiology
- Scope
- Priorities for implementation
- Costs and savings Discussion
- Find out more
- NICE Quality Standard
3Background
- Diabetes is one of the biggest health challenges
facing the UK today - Diabetic foot problems are the most common cause
of non-traumatic limb amputation - Diabetic foot problems have a significant
financial impact on the NHS and a significant
impact on patients quality of life.
All Images in this presentation are reproduced
with kind permission off Dr. Tony Coll,
University of Cambridge
4Epidemiology
- In 2010, 2.3 million people were registered as
having diabetes - Life expectancy can be reduced by up to 15 years
for people with diabetes - 15 of people with diabetes will have a foot
ulcer at some point in their lives - Diabetes is the most common cause of
non-traumatic limb amputation.
5Scope
- Key components and organisation of patient
hospital care for diabetic foot problems from
hospital admission to discharge planning - Assessment and investigation of diabetic foot
problems - Clinical and cost-effectiveness of treatments for
diabetic foot problems.
6Multidisciplinary foot care team
- Each hospital should have a care pathway for
patients with diabetic foot problems who require
inpatient care - The multidisciplinary foot care team should
consist of healthcare professionals with the
specialist skills and competencies necessary to
deliver inpatient care for patients with diabetic
foot problems.
7Patient information and support
- The patient should have a named contact to
follow the inpatient care pathway and be
responsible for - offering patients information about their
diagnosis and treatment, and the care and support
that they can expect - communicating relevant clinical information,
including documentation prior to discharge,
within and between hospitals and to primary
and/or community care.
8Initial examination and assessment
- Remove the patients shoes, socks, bandages and
dressings and examine their feet - If the following are present, obtain urgent
advice from an appropriate specialist - Charcot arthropathy (which should be considered
if deformity, redness or warmth are present) - systemic sepsis
- deep seated infection
- limb ischaemia
9Care within 24 hours
- Refer the patient to the multidisciplinary foot
care team. - Transfer the responsibility of care to a
consultant member of the multidisciplinary foot
care team if a diabetic foot problem is the
dominant clinical factor for inpatient care.
10Investigation of suspected diabetic foot infection
- If osteomyelitis is suspected and initial X-ray
does not confirm its presence, use magnetic
resonance imaging (MRI) - If MRI is contraindicated, white blood cell (WBC)
scanning may be performed instead.
11Management of diabetic foot infection
- Each hospital should have antibiotic guidelines
for the management of diabetic foot infections.
12Management of diabetic foot ulcers
- When choosing wound dressings take into account
- clinical assessment of the wound
- patient preference
- clinical circumstances
- which wound dressing has the lowest acquisition
cost.
13Costs and savings
- The guideline on the inpatient management of
diabetic foot problems is unlikely to result in a
significant change in resource use in the NHS.
However, recommendations in the following areas
may result in additional costs/savings depending
on local circumstances - Multidisciplinary foot care team
- Care within 24 hours
- Investigation of suspected diabetic foot
infection - Management of diabetic foot ulcers
14Discussion
- To what extent do local arrangements compare with
the guideline recommendations? - What should we stop doing as a result of this
guideline? - What are the training implications for staff to
support implementation of this guideline? - What are the local cost implications of
implementing the guideline?
15Find out more
- Visit www.nice.org.uk/guidance/CG119 for
- the guideline
- the quick reference guide
- Understanding NICE guidance
- costing statement
- audit support
16NICE Quality Standard
Diabetes Statement 10
17Quality standards
- A quality standard is a set of specific, concise
statements that - act as markers of high-quality, cost-effective
patient care across a pathway or clinical area,
covering treatment or prevention - are derived from the best available evidence
and produced collaboratively with the NHS and
social care, along with their partners and
service users.
18Diabetes quality standard
- The management of diabetes draws on many areas
of healthcare management. - The quality standard describes markers of
high-quality, cost-effective care that, when
delivered collectively, should contribute to
improving the effectiveness, safety and
experience and of care for adults diabetes. - The quality standard consists of 13 quality
statements.
19Quality statement 10 At risk foot
- Each of the quality statements may be of
interest to service providers, healthcare
professionals, commissioners and people with
diabetes.
20Quality statement 10 At risk foot
- Quality statement
- People with diabetes with or at risk of foot
ulceration receive regular review by a foot
protection team in accordance with NICE guidance,
and those with a foot problem requiring urgent
medical attention are referred to and treated by
a multidisciplinary foot care team within 24
hours.
21Quality statement 10 At risk foot
- Quality measure
- Evidence of local arrangements to ensure that
people with diabetes with or at risk of foot
ulceration receive regular review by a foot
protection team in accordance with NICE guidance. - Evidence of local arrangements to ensure that
people with diabetes with a foot problem
requiring medical attention are treated by a
multidisciplinary foot care team within 24 hours.
22What do you think?
- Did the implementation tool you accessed today
meet your requirements, and will it help you to
put the NICE guidance into practice? - We value your opinion and are looking for ways to
improve our tools. Please complete a short
evaluation form by clicking here. - If you are experiencing problems accessing or
using this tool, please email implementation_at_nice.
org.uk
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