Utilizing Advanced Foot Care in Prevention of Wounds/Amputation in the Patient with Diabetes Mellitus

Foot ulceration is a common and significant complication of Diabetes Mellitus. Yearly incidence is currently estimated to be 2% with lifetime incidence 15­-25% and recurrence rate of 30­-40%. Etiology is typically multifactorial and places stress on the patient, healthcare systems, and society as a whole.  It is reported that only 2/3 of foot ulcers will eventually heal and that up to 28% may result in some form of lower extremity amputation (Bus,et al. 2015). Prevention of ulceration is of utmost importance in reducing physical and financial burdens on the patient and healthcare.  At an academic, Magnet® designated, medical center in the southeastern United States, there is currently no formal standard operating procedure (SOP) by which Certified Foot Care nurses may practice.  A review of the literature revealed insufficient evidence to support interventions in the prevention of a first foot ulcer.  One systematic review reports some evidence to support interventions in the prevention of recurrent foot ulcers, with recommendations made.  The recommendations were appraised using the University of Pennsylvania’s Center for Evidence-Based Practice Trustworthy Guideline rating scale and found to be trustworthy.  An evidence based practice summary was compiled, leading to a strong recommendation with low quality of evidence.  As a result of the evidence review, a SOP is in development that will incorporate foot care guidelines as defined by the state nursing board as well as the recommendations made in the systematic review.  Implementation of this SOP will provide optimal foot care to this at risk population and will increase opportunities to add to the current evidence.