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Diabetic Foot Problems

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Diabetic Foot Problems ... If osteomyelitis is suspected, do not delay the commencement of a course of antibiotics pending the results of an MRI scan. – PowerPoint PPT presentation

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Title: Diabetic Foot Problems


1
Diabetic Foot Problems
Implementing NICE guidance
March 2011
NICE clinical guideline 119
2
What this presentation covers
  • Background
  • Epidemiology
  • Scope
  • Priorities for implementation
  • Costs and savings Discussion
  • Find out more
  • NICE Quality Standard

3
Background
  • 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
4
Epidemiology
  • 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.

5
Scope
  • 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.

6
Multidisciplinary 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.

7
Patient 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.

8
Initial 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

9
Care 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.

10
Investigation 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.

11
Management of diabetic foot infection
  • Each hospital should have antibiotic guidelines
    for the management of diabetic foot infections.

12
Management 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.

13
Costs 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

14
Discussion
  • 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?

15
Find out more
  • Visit www.nice.org.uk/guidance/CG119 for
  • the guideline
  • the quick reference guide
  • Understanding NICE guidance
  • costing statement
  • audit support

16
NICE Quality Standard
Diabetes Statement 10
17
Quality 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.

18
Diabetes 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.

19
Quality statement 10 At risk foot
  • Each of the quality statements may be of
    interest to service providers, healthcare
    professionals, commissioners and people with
    diabetes.

20
Quality 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.

21
Quality 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.

22
What do you think?
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    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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