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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.

8

Local Infection Management

People with a diabetic foot ulcer and a local infection receive appropriate treatment, including antimicrobial and non-antimicrobial interventions.


People with diabetes are more susceptible to infection (over half will develop a skin and soft tissue infection), and older individuals with diabetes may be at even higher risk if they have comorbidities, which can mask the severity of the infection. Local infection may be suspected when three or more of the following signs and symptoms are present: stalled healing (ulcer is not healing at the expected rate or is growing quickly); increased amount of exudate; red and bleeding tissue; increased amount of dead tissue; and foul odour. The severity of diabetic foot infections can be classified as mild/localized (superficial or local to the skin and subcutaneous tissue), moderate/deep (deeper wound, such as an abscess, osteomyelitis, septic arthritis, or fasciitis), or severe/systemic (local infection with signs of systemic inflammatory response syndrome).

Antibiotic therapy is not required if there is no evidence of soft-tissue or bone infection. Antibiotics should be used in alignment with organizational policies and procedures for antimicrobial stewardship.

For Patients

If your wound is infected, you should receive treatment, including antibiotics and non-antimicrobial interventions.


For Clinicians

Provide appropriate antimicrobial and non-antimicrobial treatment for people with an infected diabetic foot ulcer. Initial antimicrobial treatment includes oral narrow-spectrum antibiotic therapy aimed at gram-positive organisms for up to 2 weeks.


For Health Services

Ensure that systems, processes, and resources are in place to support clinicians in treating people with a diabetic foot ulcer and local infection.

Process Indicators

Percentage of people with a diabetic foot ulcer and a local infection who receive appropriate antimicrobial and non-antimicrobial treatment

  • Denominator: number of people with a diabetic foot ulcer and a local infection

  • Numerator: number of people in the denominator who receive appropriate antimicrobial and non-antimicrobial treatment

  • Data source: local data collection

Percentage of people with a diabetic foot ulcer and a local infection who receive oral narrow-spectrum systemic antibiotic therapy aimed at gram-positive organisms for up to 2 weeks

  • Denominator: number of people with a diabetic foot ulcer and a local infection

  • Numerator: number of people in the denominator who receive oral narrow-spectrum systemic antibiotic therapy aimed at gram-positive organisms for up to 2 weeks

  • Data source: local data collection

Local infection

This is characterized as superficial or local to the skin and subcutaneous tissue.


Treatment

For local infection, treatment may include antimicrobial and non-antimicrobial (for example, debridement) interventions. Antimicrobial treatments are based on clinical assessment (signs and symptoms, severity, likely cause, and associated susceptibilities) and may be guided by properly conducted bacterial culture techniques. Initial treatment includes oral narrow-spectrum antibiotic therapy aimed at gram-positive organisms for up to 2 weeks.

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