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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.

Health Quality Ontario thanks the following individuals for their generous, voluntary contributions of time and expertise to help create this quality standard:

Laura Teague (co-chair)
Nurse Practitioner
Wound Care, St. Michael’s Hospital

Gary Sibbald (co-chair)
Public Health and Medicine, Dermatology and Internal Medicine, University of Toronto, Trillium Health Partners

Mohamed S. Awan
Lived Experience Advisor

Jacklyn Baljit
Clinical Program Lead
Ontario Association of Community Care Access Centres

Josie Barbita
Professional Practice, Toronto Central Community Care Access Centre

Mariam Botros
Executive Director
Canadian Association of Wound Care

Catherine Butler
Vice President
Clinical Care, Champlain, Community Care Access Centre

Elaine Calvert
Quality and Clinical Practice, Thrive Group

Lucy Coppola
Erie St. Clair Community Care Access Centre

Lindsey Cosh
Circle of Care Coordinator
Southern Ontario Aboriginal Diabetes Initiative

Bridget Davidson
Executive Director
Canadian Malnutrition Task Force

Robyn Evans
Wound Healing Clinic, Family Medicine Wound Care, Women’s College Hospital

Catherine Harley
Executive Director
Wound Care (IIWCC), Canadian Association for Enterostomal Therapy

Connie Harris
Clinical Nurse Specialist
Private Practice, Clinical Consultant on Education and Research

Pamela Houghton
Physical Therapy, University of Western Ontario

Sharon Hunter
Care Manager
Nursing Program, CBI Home Health

Devon Jahnke
Chiropodist and Diabetes Educator
Health Sciences North

David Keast
Medical Director
Chronic Wound Clinic, Parkwood Institute

Kimberly LeBlanc
KDS Professional Consulting

James Mahoney
Plastic Surgeon
St. Michael’s Hospital

Colleen McGillivray
Physical Medicine and Rehabilitation
University Health Network Toronto Rehabilitation Institute

Ann-Marie McLaren
Chiropodist and Foot Specialist
Wound Team, St. Michael’s Hospital

Joshua Moralejo
Nursing Practice Leader
Salvation Army Toronto Grace Health Centre

Linda O’Rourke
Lived Experience Advisor

Deirdre O’Sullivan-Drombolis
Physical Therapist
Riverside Health Care

Norma Skinner
Community Care Coordinator
Thunder Bay Short Stay Wound and Medical Supply;
North West Community Care Access Centre

Karen Smith
Associate Professor and Associate Dean
Continuing Professional Development
Queen’s University

Michael Stacey
Vascular Surgeon
Hamilton Health Sciences Centre and McMaster University

Ruth Thompson
Ottawa Hospital

Evelyn Williams
Ontario Long-Term Care Clinicians

Valerie Winberg
Nurse Practitioner
Twin Bridges Nurse Practitioner–Led Clinic

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