New Risk of Developing Foot Disease · 2020. 4. 14. · Pre-ulcerative lesions: Includes corns,...
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INTEGRATED DIABETES FOOT CARE PATHWAY PAD and Pain on rest or Gangrene or Lower limb ulceration >2 weeks duration An unexplained swollen foot with or without pain Definition Action Plan Active Foot Disease Foot Ulcer with Systemic Infection Foot Ulcer +/- Local Infection Acute Limb Ischaemia Chronic Limb - Threatening Ischaemia Charcot Foot Sudden onset foot pain, pallor or coldness present over hours or days Foot ulcer with local infection with Systemic Features +/- SIRS Refer immediately to ED Refer immediately to ED For complex moderate infection +/- complicated by comorbities - refer to ED Otherwise, in most cases: Initiate appropriate antibiotic therapy and collection of microbiology specimens Same day referral to IHRFS (or similar discplines if no IHRFS exists locally) for wound care and offloading (pressure management) Same day referral to IHRFS (or similar IHRFS disciplines if no IHRFS exists locally) Same day referral to a vascular specialist Active Foot Disease Advise all members of the healthcare team of any change in risk status In liaison with GP/IHRFS or similar: Dress ulcer with an appropri- ate wound dressing (absorb exudate) Clinical handover to include: Ulcer description History Treatment today If same day IHRFS appointment is not available, immobilise the affected leg in knee-high cast/boot and/or wheelchair Address infection if present To facilitate faster triage, in referral briefly describe: Ulcer site Ischaemia Neuropathy Infection Area and depth status Practice Points Foot ulcer +/- local infection but no systemic features: Mild – <2cm erythema peri-wound AND skin & subcutaneous tissue or Moderate – erythema >2cm deeper structures (i.e. tendon/bone) Aboriginal and Torres Strait Islander people should be considered "High Risk" until assessed otherwise - consider cultural safety when conducting a foot assessment and providing foot care advice References International Working Group Diabetic Foot Guidelines – 2019, NICE UK guidelines: Diabetic foot problems: prevention and management, National Evidence-Based Guideline on Prevention, Identification and Management of Foot Complications in Diabetes (Part of the Guidelines on Management of Type 2 Diabetes) 2011. Melbourne Australia Systemic Features: Fever, chills, hypotension, confusion and volume depletion LOPS: Loss of Protective Sensation (sign of diabetic polyneuropathy) PAD: Peripheral Arterial Disease IHRFS: Interdisciplinary High Risk Foot Service or Foot Clinic SIRS: Systemic Inflammatory Response Syndrome (refer to local guidelines) ED: Emergency department ESRD: End stage renal disease Definitions Acronyms Specialist referrals: Interdisciplinary High Risk Foot Services (HRFS) or similar (wound clinic), Vascular Surgeon, Podiatrist, Primary care (GP clinic), Diabetes centre or Endocrinologist, Suitably trained healthcare worker: Aboriginal Heath Worker, Allied Health Assistant, Emergency Department Key modifiable risk factors: Includes smoking, diet, diabetes control, hyperlipidaemia, blood pressure, exercise, weight management Comorbities: For example: severe peripheral artery disease, renal failure, immunocompromised state Pre-ulcerative lesions: Includes corns, callus, tinea pedis, thickened toenails (+/- fungal infection), heel fissures. Treatment should be undertaken by a podiatrist (or similarly competent foot practitioner) Risk of Developing Foot Disease Treat any pre-ulcerative lesions Prescribe therapeutic footwear (Risk 3) and/or orthotic intervention Develop personalised Foot Health Plan Share outcomes with the healthcare team Undertake regular structured foot care education Risk of Developing Foot Disease High Moderate Low Very Low Foot Protection Plan In some states basic foot care may be provided by suitably trained healthcare workers Develop self-management plan that supports preventative self-care behaviours Action Plan 12M Refer to a podiatrist (or similarly competent foot practitioner) Provide structured foot care education Develop Foot Protection Plan Review footwear Optimise diabetes and vascular management Address key modifiable risk factors Risk Risk Factors LOPS or PAD and one or more of the following: History of foot ulcer A lower extremity amputation (minor or major) ESRD LOPS + PAD or LOPS + Foot deformity or PAD + Foot deformity LOPS or PAD No LOPS and No PAD Re-screening Examine every 12 months 6-12M 12 M Re-screen and enact action plan every Podiatry referral within 1 - 3 months 2 - 4 weeks Re-screen and enact action plan every Podiatry referral within 3 - 6 months 6 - 8 weeks 2-4W 1-3M 6-8W 3-6M Re-screen and enact action plan every 6 - 12 months 0 1 2 3 Advise all members of the healthcare team of any change in risk status Foot ulceration and the consequences Preventative foot self-care behaviours, such as: Seeking professional help in a timely manner after identifying a foot problem Not walking barefoot in socks without shoes or in thin soled slippers Wearing adequately protective footwear Undergoing regular foot checks Practicing proper foot hygiene Structured foot care education should include
Transcript of New Risk of Developing Foot Disease · 2020. 4. 14. · Pre-ulcerative lesions: Includes corns,...
INTEGRATED DIABETES FOOT CARE PATHWAY
PAD andPain on rest or Gangrene or Lower limb ulceration >2 weeks duration
An unexplained swollen foot with or without pain
Definition Action Plan
Active Foot Disease
Foot Ulcer with Systemic Infection
Foot Ulcer +/- Local Infection
Acute Limb Ischaemia
Chronic Limb - Threatening
Ischaemia
Charcot Foot
Sudden onset foot pain, pallor or coldness present over hours or days
Foot ulcer with local infection with Systemic Features +/- SIRS Refer immediately to ED
Refer immediately to ED
For complex moderate infection +/- complicated by comorbities - refer to ED
Otherwise, in most cases:
Initiate appropriate antibiotic therapy and collection of microbiology specimens
Same day referral to IHRFS (or similar discplines if no IHRFS exists locally) for wound care and offloading (pressure management)
Same day referral to IHRFS (or similar IHRFS disciplines if no IHRFS exists locally)
Same day referral to a vascular specialist
Active Foot Disease
Advise all m
embers of the healthcare team
of any change in risk status
In liaison with GP/IHRFS or similar:
Dress ulcer with an appropri-ate wound dressing (absorb exudate)
Clinical handover to include:
Ulcer description
History
Treatment today
If same day IHRFS appointment is not available, immobilise the affected leg in knee-high cast/boot and/or wheelchair
Address infection if present
To facilitate faster triage, in referral briefly describe:
Ulcer site
Ischaemia
Neuropathy
Infection
Area and depth status
Practice Points
Foot ulcer +/- local infection but no systemic features:
Mild – <2cm erythema peri-wound AND skin & subcutaneous tissue or
Moderate – erythema >2cm deeper structures (i.e. tendon/bone)
Aboriginal and Torres Strait Islander people should be considered "High Risk" until assessed otherwise - consider cultural safety when conducting a foot assessment and providing foot care advice
References International Working Group Diabetic Foot Guidelines – 2019, NICE UK guidelines: Diabetic foot problems: prevention and management,
National Evidence-Based Guideline on Prevention, Identification and Management of Foot Complications in Diabetes (Part of the Guidelines on Management of Type 2 Diabetes) 2011. Melbourne Australia
Systemic Features: Fever, chills, hypotension, confusion and volume depletion
LOPS: Loss of Protective Sensation (sign of diabetic polyneuropathy)
PAD: Peripheral Arterial Disease
IHRFS: Interdisciplinary High Risk Foot Service or Foot Clinic
SIRS: Systemic Inflammatory Response Syndrome (refer to local guidelines)
ED: Emergency department
ESRD: End stage renal disease
Definitions Acronyms
Specialist referrals: Interdisciplinary High Risk Foot Services (HRFS) or similar (wound clinic), Vascular Surgeon, Podiatrist, Primary care (GP clinic), Diabetes centre or Endocrinologist, Suitably trained healthcare worker: Aboriginal Heath Worker, Allied Health Assistant, Emergency Department
Key modifiable risk factors: Includes smoking, diet, diabetes control, hyperlipidaemia, blood pressure, exercise, weight management
Comorbities: For example: severe peripheral artery disease, renal failure, immunocompromised state
Pre-ulcerative lesions: Includes corns, callus, tinea pedis, thickened toenails (+/- fungal infection), heel fissures. Treatment should be undertaken by a podiatrist (or similarly competent foot practitioner)
Risk of Developing Foot Disease
Treat any pre-ulcerative lesions
Prescribe therapeutic footwear (Risk 3) and/or orthotic intervention
Develop personalised Foot Health Plan
Share outcomes with the healthcare team
Undertake regular structured foot care education
Risk of Developing Foot Disease
High
Moderate
Low
Very Low
Foot Protection Plan
In some states basic foot care may be provided by suitably trained healthcare workers
Develop self-management plan that supports preventative self-care behaviours
Action Plan
12M
Refer to a podiatrist (or similarly competent foot practitioner)
Provide structured foot care education
Develop Foot Protection Plan
Review footwear
Optimise diabetes and vascular management
Address key modifiable risk factors
Risk Risk Factors
LOPS
or
PAD
and one or more of the following:
History of foot ulcer
A lower extremity amputation (minor or major)
ESRD
LOPS + PAD
or
LOPS + Foot deformity
or
PAD + Foot deformity
LOPS or PAD
No LOPS
and
No PAD
Re-screening
Examine every 12 months
6-12M
12 M
Re-screen and enact action plan
every
Podiatry referral within
1 - 3 months
2 - 4 weeks
Re-screen and enact action plan
every
Podiatry referral within
3 - 6 months
6 - 8 weeks
2-4W
1-3M
6-8W
3-6M
Re-screen and enact action plan
every6 - 12 months
0
1
2
3
Advise all m
embers of the healthcare team
of any change in risk status
Foot ulceration and the consequences
Preventative foot self-care behaviours, such as:
Seeking professional help in a timely manner after identifying a foot problem
Not walking barefoot in socks without shoes or in thin soled slippers
Wearing adequately protective footwear
Undergoing regular foot checks
Practicing proper foot hygiene
Structured foot care education should include
