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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.

3

Referral to an Interprofessional Team

People 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.


The effective management of diabetic foot ulcers to prevent recurrence and amputation requires coordinated and specialized interprofessional collaboration between care settings (primary care, inpatient, and outpatient). An integrated approach recognizes that a single specialist does not have all of the skills and knowledge to effectively manage and treat people with diabetic foot ulcers. The members of the team do not need to operate at a single location. People will require access to different types and levels of care, depending on their level of risk. People who have peripheral neuropathy and a history of foot ulcers or amputation, as well as people who have an active diabetic foot ulcer or complication, require access to a team that specializes in diabetic foot care and includes experts from many disciplines working together.

For Patients

If you have a diabetic foot ulcer, you should be referred to a team of care providers. If you have major complications, you should be seen within 24 hours by a team that delivers emergency services and then be referred to a team of health care professionals for ongoing care.


For Clinicians

Ensure people with a diabetic foot ulcer are referred to an interprofessional team. Ensure people with a diabetic foot ulcer and major complications are seen within 24 hours by emergency services, and then refer them to an interprofessional team for ongoing care.


For Health Services

Ensure that systems and procedures are in place so that people with diabetic foot ulcers receive care from an interprofessional team. Ensure that systems and procedures are in place so that people with diabetic foot ulcers and major complications are seen within 24 hours by a team that delivers emergency services and then referred to an interprofessional team for ongoing care.

Process Indicators

Percentage of people with a diabetic foot ulcer who are referred to an interprofessional team that delivers ongoing, coordinated, integrated care

  • Denominator: number of people with a diabetic foot ulcer

  • Numerator: number of people in the denominator who are referred to an interprofessional team that delivers ongoing, coordinated, integrated care

  • Data source: local data collection


Percentage of people with a diabetic foot ulcer and major complications who are seen within 24 hours by a team that delivers emergency services

  • Denominator: number of people with a diabetic foot ulcer and major complications
  • Numerator: number of people in the denominator who are seen within 24 hours by a team that delivers emergency services
  • Data source: local data collection
Interprofessional team

This includes the following:

  • Most people with diabetic foot ulcers require access to a primary care practitioner, a podiatrist or chiropodist, and a diabetes nurse
  • People with peripheral neuropathy, peripheral arterial disease, and/or a foot deformity may also require access to an endocrinologist, one or more surgeons (e.g., orthopedic or vascular), and a radiologist

Major complications

These are limb- and/or life-threatening and include acute ischemia, signs and symptoms of deep/surrounding tissue infection or systemic infection, osteomyelitis, and acute Charcot arthropathy.

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