Advanced Foot Care: Identification, Implementation, & Sustainment of a Successful Program

Jennifer OBrien, RN, BSN, CWOCN, CFCN, UNC Hospitals, Chapel Hill, NC, Krystyna Dixon, MSN, RN, CWOCN, CFCN, Duke Raleigh Hospital, Acute Care Nurse Clinician, Ostomy Clinic Coordinator, Raleigh, NC and Tracy Carroll, MSN, RN, NE-BC, CMSRN, Heart and Vascular Services, UNC Hospitals, Chapel Hill, NC
In the acute care setting, the bedside nurse’s comfort level with foot care is generally limited to routine skin care and personal hygiene. Foot and nail assessment, clinically appropriate care, and patient education are essential for improving foot health and preventing complications.

For decades, hospitals have been unable to provide foot and nail care due to numerous challenges including limited resources and specialists and a lack of formal programming. This was recognized at our academic medical center and a taskforce, comprised of a Certified Foot Care Nurse (CFCN) and the unit manager, was formed to initiate an Advanced Foot Care Program as part of the WOC Nurse consult service for hospitalized patients.

The first phase of the program development was a partnership with a fellow CFCN at another local academic medical center. By working together and sharing ideas, both CFCN's were able to develop specialized foot care programs at their respective institutions.

The second phase was policy writing and approval, equipment procurement, and determination of a sterilization process. An order set for ‘CFCN consult’ was added to the electronic medical record. Staff awareness of the Advanced Foot Care Program was promoted through presentations, email notifications, rounding, and unit postings.

The third phase involved providing care to patients needing foot care. Additional consults were obtained as bedside staff became more familiar with the resources available and the benefits of foot care.

In 7 months, more than 90 patients received advanced foot care between the two organizations.

Feedback from staff has been very positive and promotion of the programs continues. Patient satisfaction has been the most rewarding aspect and has been confirmation for this much needed advanced service. The WOC Nurse's at each entity continue to work together to make program enhancements and share best practices related to foot care.