Abstract: Best Practice Guidelines and Algorithm established for treatment and referral of patients with Diabetic Foot Ulcers (49th Annual Conference (May 19-23, 2017))

Annette Gwilliam, BSN, RN, CWCN, ACHRN, Baromedical Nurses Association (BNA), Provo, UT, Deb Critz, BSN, RN, ACHRN, Baromedical Nurses Association Certification Board (BNACB), Des Moines, IA and Richard "Gus" Gustavson, MPH, RN, CHRNC, CWCN, CHT, CRT, Undersea and Hyperbaric Medical Society (UHMS), Las Vegas, NV

The prevalence of diabetes [in the U.S.] increased from 0.93% in 1958 to 7.02% in 2014 and continues to rise. In 2014, 21.9 million people had diagnosed diabetes (DM), with only 1.6 million in 1958¹.

This increase in DM creates a need for programs to screen patients who will likely have complications including: cardiovascular disease, kidney failure, visual impairments and lower extremity conditions including amputations².

Problem wounds are increasing in prevalence resulting in growing healthcare cost and utilization of resources; diabetic foot ulcers (DFU) account for 60% of amputations³. Through appropriate interventions patients can improve their quality of life (QOL) and slow or stop the cycle of destruction. There are times that this includes referral for Hyperbaric Oxygen treatments (HBO2).

Our purpose is to share clinical practice guidelines for DFU's as researched and recommended by the Undersea and Hyperbaric Medical Society. Included with this research is a very detailed algorithm that will guide the clinician through: wound assessment, the environment of care, vascular evaluation and referrals.

Wound Assessment: Includes evaluation of debridement options, infection, wound bed preparation and periwound environment.
Environment of care: Treatment of underlying infection, controlled blood sugars, nutrition, lab values, offloading and behavior modification to promote healing.
Testing and Vascularization: Transcutaneous oximetry monitoring (TCOM) provides a direct, quantitative assessment of oxygen availability to the peri-wound skin and an indirect measurement of peri-wound microcirculatory blood flow⁴. This can be a significant predictor of limb salvage.
Referral guidelines: Compromised DFU’s that have been present for greater than 30 days, classified as Wagner 3 (or higher) or shows signs of ischemia. Add HBO2 post-op to the standard of care to reduce the risk of major amputation and incomplete healing^3,4.

As Wound/Hyperbaric nurses use these guidelines, DFU’s can be treated appropriately and the rate of healing will increase, therefore improving QOL.