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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.

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.


Transitions in care involve changes in providers or locations (within and between care settings) and can increase the risk of errors and miscommunication related to a person’s care. To support coordination and continuity of care, transition planning should be collaborative, involving the person with the diabetic foot ulcer, their family, and their caregiver(s), and incorporating their individual concerns and preferences. To support the transfer of accurate information, all providers must document the most up-to-date information in the individualized care plan. A provider or team should be accountable for ensuring the accurate and timely transfer of information on an ongoing basis to the proper recipients as part of seamless, coordinated transitions.

For Patients

When you change health care settings (for example, you return home after being cared for in a hospital), your health care team or health care professional should work with you to make sure that important information is transferred with you, and that you are connected to the supports you need.


For Clinicians

Ensure that people moving between providers or care settings have a person or team responsible for coordinating their care and transferring information.


For Health Services

Ensure that systems, processes, and resources are in place to enable smooth transitions between care settings for people with a diabetic foot ulcer or foot complications.

Process Indicators

Percentage of people with a diabetic foot ulcer who transition between care settings and have a team or provider who is accountable for coordination and communication to ensure the effective transfer of information related to their care

  • Denominator: number of people with a diabetic foot ulcer who transition between care settings

  • Numerator: number of people in the denominator who have a team or provider who is accountable for coordination and communication to ensure the effective transfer of information related to their care

  • Data source: local data collection


Percentage of people with a diabetic foot ulcer who transition between care settings and report that their team or provider knew about their medical history

  • Denominator: number of people with a diabetic foot ulcer who transition between care settings and answer the question, “During your most recent visit, did this team or provider seem to know about your medical history?”
  • Numerator: number of people in the denominator who answer “Yes”
  • Data source: local data collection

Percentage of people with a diabetic foot ulcer who transition between care settings and report that there was good communication between their team and care providers

  • Denominator: number of people with a diabetic foot ulcer who transition between care settings and answer the question, “Do you feel that there was good communication about your care between your team, doctors, nurses, and other staff?”
  • Numerator: number of people in the denominator who answer “Usually” or “Always”
  • Data source: local data collection
Foot complications

These include factors that may lead to soft-tissue breakdown and ulceration, such as dry skin, callus, blister, deformities, minor fractures, and subacute Charcot arthropathy.


Team or provider

This is the provider or team of providers who have an ongoing role in the coordination and delivery of health care services for the person who has developed a diabetic foot ulcer or foot complications. Where possible, this should be a primary care provider or primary care team. Alternatively, an individual at the regional level who is responsible for care coordination could fill this role.

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