Every 30 seconds a lower limb is lost somewhere in the world as a consequence of Diabetes. The...
-
Upload
kristian-nay -
Category
Documents
-
view
215 -
download
0
Transcript of Every 30 seconds a lower limb is lost somewhere in the world as a consequence of Diabetes. The...
Every 30 seconds a lower limb is lost somewhere in
the world as a consequence of Diabetes.
The Lancet Volume 366
Issue 9498
Diabetic Foot ScreeningPathways, Posters and Leaflets
Produced by: Foot and Lower Limb Working Group
Approved by: East Lancashire Diabetes Network Clinical Standards Group
Approved for use in: Lancashire CareEast Lancashire Hospitals NHS Trust
ANNUAL SCREENING REVIEW
Symptoms - Claudication - Pain - History of Ulcer - Visual Impairment - Mobility Problems
Inspection - Callus - Deformity - Ulcer Present
Examination - Skin Condition - Pulses Present - Sensitive to 10g pressure (loss of 10g= HIGH RISK)
CATEGORISE RISK
LOW RISK 0 Normal Flow
MODERATE RISK 1 +/- Arterial Disease
HIGH RISK 2 +/- Arterial Disease
VERY HIGH RISK 3 +/- Arterial Disease
ARTERIAL DISEASE +
- Protective Sensation Intact (10g Pressure)
- Optimise Diabetes & Blood Pressure Control (<139/80) - Foot Education - Low Risk Advice Sheet
Podiatry Only For Problems
- Loss of Protective Sensation (10g Pressure) - No Deformity - No Callus - No Previous Ulcer
- Optimise Diabetes & Blood Pressure Control (<139/80) - Foot Education - Moderate Risk Advice Sheet - Consider Consultant Opinion - Footwear Assessment (consider referral to Orthotist) Regular Podiatry
(12 Weekly)
- Loss of Protective Sensation (10g Pressure) - Deformity or Callus Present - No Previous Ulcer
Regular Podiatry (4-12 Weekly)
- Loss of Protective Sensation (10g Pressure) - Ulcer Present or Previous Ulcer
- Optimise Diabetes & Blood Pressure Control (<139/80) - Foot Education - High Risk Advice Sheet - Consultant Opinion - Specialist Prescribed Footwear or Shoe Review
- Optimise Diabetes & Blood Pressure Control (<139/80) - Foot Education - Very High Risk Advice Sheet - Consultant Opinion - Specialist Prescribed Footwear or Shoe Review
- Abnormal flow - +/- History of Claudication
If You Suspect Acute Vascular Insufficiency Ring: 01254 734 794
- Optimise Diabetes & Blood Pressure Control (<139/80) - Prescribe Aspirin or Statin - “Stop Smoking & Keep Walking” - Foot Education/ Arterial Disease Advice Sheet - Consider Consultant Opinion - Specialist Prescribed Footwear or Shoe Review
Regular Podiatry (1-4 Weekly)
Regular Podiatry (1-4 Weekly)
ANNUAL REVIEW REGISTRATION
Advice & Urgent Assessments Diabetes Footline Blackburn:
07866 684 362 (Diabetes Specialist Podiatrist or Nurse)
Podiatry Referrals (Clinic or Domiciliary Visits)
Contact Local Health Centres
Footwear Initial Supply- Consultant Referral
Repairs & Renewals Blackburn: 01254 294 040 Burnley: 01282 804 602
LOW RISK Protective sensation intact
(10g pressure)
Optimise diabetes and blood pressure control (<139/80)
Foot education/Low risk leaflet
Podiatry only for problems
MODERATE RISK • Loss of protective sensation
• No deformity
• No callus
• No previous ulcer
• Optimise diabetes and blood pressure control (<139/80)
• Foot education/Moderate risk leaflet
• Consider Consultant opinion
• Footwear advice and assessment
Regular Podiatry (12 weekly)
HIGH RISK
• Loss of protective sensation• Deformity and/or callus present• No previous ulcer
• Optimise diabetes and blood pressure control (<139/80)• Foot education/High risk leaflet• Consultant opinion• Specialist prescribed Footwear/Shoe review
Regular Podiatry (4 – 12 weekly)
Very High Risk• Loss of protective sensation (10 g pressure)
• Ulcer present or
• Previous ulcer
• Optimise diabetes & blood pressure control (<130/80)
• Foot education leaflets/ very high risk leaflet
• Consultant opinion
• Specialist prescribed footwear / shoe review
Regular podiatry and review (1-4 weekly)
Arterial Disease• Abnormal flow• +/- History of claudication
• If you suspect acute vascular insufficiency telephone: 07793 119344
• Optimise diabetes & blood pressure control (>139/80)
• Prescribe aspirin/statin• ‘Stop smoking and keep walking’• Foot education/leaflet • Consider consultant opinion• Specialist prescribed footwear /shoe review
Regular Podiatry especially nail care (1-12 weekly)
Annual Screening Review
Advice and Urgent Assessments:-
Screening referrals:- fax 617287 phone 282708
Podiatry Referrals: – Local Health Centres
Footwear: – Initial supply – Consultant referral Repairs and renewals:
Blackburn – 01254 734040
Burnley -- 01282 804602
Hot Foot Line: – Blackburn 07866684362
Lomax.G. McLaughlin.C. 2002
Referral Pathways For The Diabetic Foot
Referral for Diabetic Footwear
Referral for Non-urgent Problems
Referral for Urgent Problems
Urgent Patient
Same Day Referral
Ring :-Diabetes Hot Foot line 07866684362 Condition becomes
urgent refer via RED Pathway
Continue treatment until Outpatient Appointment
Non Urgent Patient
Referral letter, or fax (01254 736032)Dr G.R. Jones, Diabetes unit, RBH
New patient
Existing patient
Letter of Referral to Dr G.R. Jones, Diabetes unit, RBH
Prescribed footwear
OrthoticsRBH01254 294040BGH01282 804602
OrthoticsRBH 01254 294040BGH 01282 804602
Ulceration/Hot FootREFER patients to a multidisciplinary foot care team within
24 hours if any of the following occur:
• new ulceration (wound)• new swelling• new discolouration (redder, bluer, paler, blacker, over
part or all of foot).
(NICE Guideline – Type 2 diabetes: prevention and management of
foot problem)
REFER non-healing wounds from 0 – 4 weeks duration
The Diabetic Foot Clinics
Since 1987 to heal foot ulceration Multi-disciplinary team Out Patients – Shorter or no admission One stop clinic with holistic care Management plan/ Shared care Reduced no of amputations Maintain patients independence Easy accessibility
The Diabetic Foot Clinics
Pressure Relief
The Diabetic Foot Clinics
PRESCRIBED INSOLES AND FOOTWEAR CAN PREVENT FOOT PATHOLOGY
The Diabetic Foot Clinics
Ulcers are healed
Shoes and insoles are fitted/Lifelong review
Discharged back to you
Refer back at any time