Stepping Up for Diabetic Feet

Topic:   Twenty-five percent of all diabetics will develop a neuropathic ulcer requiring health care interventions with twenty percent requiring amputation.  The five year mortality after a limb amputation is 68%.  Diabetic foot care including inspection is a supported evidence based practice for multiple disciplines across the care settings. 

Purpose:  As evidence based project, our multidisciplinary team assessed staff and patient diabetic foot care practices.   Physicians, rehab team and nurses were surveyed as to direct visual foot exam components including consensual aspects of diabetic foot care.  The rehab team directly observed patients ability to visualize their plantar surfaces.

Objective: Our goal was to identify  gaps in  current multidisciplinary practices as compared to best practices regarding diabetic foot care and identify our patient population’s ability to adhere to daily foot care inspection.

Outcome:   Findings identified gaps in practices between the disciplines, specifically related to visual inspections, specifically assessing for neuropathy, footwear  and inquiring as to past foot ulceration history.  72% of the sample size did not document diabetic foot care education.  65% of patients evaluated were unable to see letters plantar sited due to limited range of motion, cognition, pain, visual and balance issues.

Conclusion:   Significant gaps between best practices for diabetic foot care, actual practice and the patient’s ability to visualize their feet were identified.  Opportunities for discipline and organizational specific strategies were identified.  The impact of a team, caregiver and evidence based approach to clinical care was appreciated.