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Evidence to Improve Care

Diabetic Foot Ulcers

Care for Patients in All Settings

Click below to see a list of brief quality statements and scroll down for more information.​​


Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence.

See below for the quality statements and click for more detail.​


Quality Statement 1: Risk Assessment
People with diabetes are assessed for their risk of developing a diabetic foot ulcer when they are diagnosed with diabetes and at least once a year thereafter. Patients at higher risk are assessed more frequently. All risk assessments are performed using standard, validated tools.


Quality Statement 2: Patient Education and Self-Management
People with diabetes and their families or caregivers are offered education about diabetic foot care and complications, including basic foot care; how to prevent foot complications and monitor for the signs and symptoms of foot complications; and who to contact in the event of a concerning change.


Quality Statement 3: Referral to an Interprofessional Team
le with a diabetic foot ulcer are referred to an interprofessional team that delivers ongoing, coordinated, integrated care. If they have major complications, they are seen within 24 hours by a team that delivers emergency services and then referred to an interprofessional team for ongoing care.


Quality Statement 4: Comprehensive Assessment
People with a diabetic foot ulcer or foot complications undergo a comprehensive assessment that informs their individualized care plan and includes evaluation of vascular status, the presence of infection, and pressure redistribution to determine the healing potential of the wound.


Quality Statement 5: Individualized Care Plan
People with a diabetic foot ulcer or foot complications have a mutually agreed-upon individualized care plan that identifies patient-centred concerns and is reviewed and updated regularly.


Quality Statement 6: Pressure Redistribution
People with a diabetic foot ulcer or foot complications are offered pressure-redistribution devices as part of their individualized care plan.


Quality Statement 7: Wound Debridement
People with a diabetic foot ulcer have their wound debrided if it is determined as necessary in their assessment, and if it is not contraindicated. Debridement is carried out by a trained health care professional using an appropriate method.


Quality Statement 8: Local Infection Management
People with a diabetic foot ulcer and a local infection receive appropriate treatment, including antimicrobial and non-antimicrobial interventions.


Quality Statement 9: Deep/Surrounding Tissue Infection or Systemic Infection Management
People with a diabetic foot ulcer and a suspected deep/surrounding tissue infection or systemic infection receive urgent assessment (within 24 hours of initiation of care) and systemic antimicrobial treatment.


Quality Statement 10: Wound Moisture Management
People with a diabetic foot ulcer receive wound care that maintains the appropriate moisture balance or moisture reduction in the wound bed.


Quality Statement 11: Health Care Provider Training and Education
People who have developed or are at risk of developing a diabetic foot ulcer or foot complications receive care from health care providers with training and education in the assessment and management of diabetic foot ulcers and foot complications.


Quality Statement 12: Transitions in Care
People with a diabetic foot ulcer or foot complications who transition between care settings have a team or provider who is accountable for coordination and communication to ensure the effective transfer of information related to their care.

10

Wound Moisture Management

People with a diabetic foot ulcer receive wound care that maintains the appropriate moisture balance or moisture reduction in the wound bed.


Wound care that maintains moisture balance to promote healing includes cleansing of the wound (tap water is usually sufficient) and selection of a dressing that promotes a moist wound healing environment (for healable ulcers) or moisture reduction (for maintenance ulcers and non-healable ulcers). Cleansing the wound promotes healing by supporting improved wound assessment, increased comfort when adherent dressings are removed, and the potential for rehydration of the wound.

There are many options for wound dressings. Selection of these products should be based on clinical assessment of the wound; patient preference; pain management considerations; and the ability to maintain a moist wound bed, control exudate, and avoid breakdown of the surrounding skin.

For Patients

Your health care team will determine whether your wound can heal or not. You should have a dressing that keeps the wound moist if it can heal, or dry if it cannot heal.


For Clinicians

For people with a diabetic foot ulcer, provide wound care that maintains the appropriate moisture balance or moisture reduction in the wound bed. A moist wound environment is appropriate for healable, non-ischemic ulcers. Moisture reduction is appropriate for maintenance, non-healable, and ischemic ulcers.


For Health Services

Ensure that systems, procedures (protocols), and resources are in place to support clinicians in providing wound care that maintains the appropriate moisture balance or moisture reduction in the wound bed.

Process Indicators

Percentage of people with a healable diabetic foot ulcer who receive wound care that maintains the appropriate moisture balance in the wound bed and a moist wound environment

  • Denominator: number of people with a healable diabetic foot ulcer
  • Numerator: number of people in the denominator who receive wound care that maintains the appropriate moisture balance in the wound bed and a moist wound environment
  • Data source: local data collection

Percentage of people with a maintenance or non-healable diabetic foot ulcer who receive wound care that maintains the appropriate moisture reduction in the wound bed

  • Denominator: number of people with a maintenance or non-healable diabetic foot ulcer
  • Numerator: number of people in the denominator who receive wound care that maintains the appropriate moisture reduction in the wound bed
  • Data source: local data collection
Moisture management

This is specific to the type of wound:

  • Moisture balance and a moist wound environment for healable ulcers (ulcers that have adequate blood supply and can be healed if the underlying cause is addressed and treated) and non-ischemic ulcers. Note: increased moisture is a sign of infection, which should be treated
  • Moisture reduction for maintenance ulcers (ulcers that have healing potential, but barriers are present that may prevent healing, such as lack of access to appropriate treatment and poor adherence to treatment), non-healable ulcers (ulcers that are not likely to heal because of non-treatable causes or illnesses), and ischemic ulcers

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