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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.

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.


Providing education to people who have developed or are at risk of developing a diabetic foot ulcer, as well as their families and caregivers, can enable them to play an active role in foot examination and care. People involved in self-management can help prevent an initial ulcer, detect the signs and symptoms of an ulcer early on, monitor existing ulcers to prevent complications, and prevent recurrent ulceration. Educational materials should be offered in both oral and written formats and be tailored to a person’s language and education level where possible, to support understanding. Written materials should also include pictures and diagrams to help people monitor for the signs and symptoms of foot complications and identify any concerning changes.

For Patients

You and your family or caregiver should be taught how to take care of your feet. You should also be taught how to check for foot problems such as ulcers, and who to contact for help.


For Clinicians

Offer people with diabetes and their families or caregivers education about diabetic foot care and complications, including basic foot care; how to prevent foot complications and monitor for the signs and symptoms of complications; and who to contact in the event of a concerning change.


For Health Services

Ensure the availability of educational materials on diabetic foot care and complications for people with diabetes and their families and caregivers.

Process Indicators

Percentage of people with diabetes and their families or caregivers who are offered education about basic foot care

  • Denominator: number of people with diabetes

  • Numerator: number of people in the denominator who, along with their families or caregivers, are offered education about basic foot care

  • Data source: local data collection


Percentage of people with diabetes and their families or caregivers who are offered education about how to prevent foot complications, how to monitor for the signs and symptoms of foot complications, and who to contact in the event of a concerning change

  • Denominator: number of people with diabetes

  • Numerator: number of people in the denominator who, along with their families or caregivers, are offered education (such as printed materials, video presentations, and in-person resources/instruction) about how to prevent foot complications, how to monitor for the signs and symptoms of foot complications, and who to contact in the event of a concerning change

  • Data source: local data collection


Structural Indicator

Availability of diabetes education materials that provide foot care education for people with diabetes and their caregivers

Education

This should be interactive, done in partnership with patients, and include the following topics:

  • When diabetes is diagnosed and during follow-up risk assessments (see Quality Statement 1):
    • Self-management skills, including goal-setting and problem-solving
    • Individual risk of developing an ulcer
    • Basic foot care (callus care; nail care, including cutting toenails straight across; and skin care, including daily foot inspections and washing)
    • How to protect feet and avoid foot trauma
    • Safe exercise
    • Smoking cessation
    • Properly fitting footwear
    • Monitoring for the signs and symptoms of ulcers
    • Diabetes management information, nutrition education, and blood glucose control
    • Who to contact in case of a concerning change
  • When diabetic foot ulcers occur, as part of the individualized, integrated care plan:
    • Overview of the type of ulcer
    • How to care for the other foot
    • Pressure-redistribution devices and offloading
    • Wound care
    • Diabetes management information, nutrition education, and blood glucose control
    • Who to contact in case of a concerning change

Concerning changes

These include signs and symptoms of a foot ulcer or complication, such as loss of protectivewri sensation; skin discolouration (a red or dusky colour indicating possible dependent rubor or gangrene); skin temperature change (an increase could mean infection, and a decrease could mean ischemia); foot pressure injury (damage to the skin and/or underlying soft tissue); change in pain or new pain; swelling; or odour.

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