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Foot problems requiring urgent medical attention

Quality statement

People with diabetes with a foot problem requiring urgent medical attention are referred to and treated by a multidisciplinary foot care team within 24 hours.

Quality measure

Structure

a) Evidence of local arrangements to ensure that people with diabetes with a foot problem requiring urgent medical attention are treated by a multidisciplinary foot care team within 24 hours.

Process

a) Proportion of people with diabetes with a foot problem requiring urgent medical attention referred to and treated by a multidisciplinary foot care team within 24 hours.

Numerator - the number of people in the denominator referred to and treated by a multidisciplinary foot care team within 24 hours.

Denominator - the number of people with diabetes with a foot problem requiring urgent medical attention.

b) Proportion of people with diabetes with a foot problem requiring urgent medical attention referred to a multidisciplinary foot care team who are treated in accordance with NICE guidance.

Numerator - the number of people in the denominator treated in accordance with NICE guidance.

Denominator - the number of people with diabetes with a foot problem requiring urgent medical attention referred to a multidisciplinary foot care team.

Outcome

a) Rates of lower limb amputation.

Description of what the quality statement means for each audience

Service providers ensure that people who have a foot problem which requires urgent medical attention have access to treatment by a multidisciplinary foot care team within 24 hours of the referral being initiated.

Healthcare professionals ensure they are aware of local arrangements for accessing a multidisciplinary foot care team within 24 hours for people with diabetes who have a foot problem requiring urgent medical attention.

Commissioners ensure they commission services that provide access to a multidisciplinary foot care team for people with diabetes who have a foot problem requiring urgent medical attention within 24 hours.

People with diabetes who have foot problems needing urgent medical attention are seen and treated by a specialist healthcare team within 24 hours.

Source clinical guideline references

NICE clinical guideline 119 recommendations 1.1.3, 1.1.4 and 1.1.9 (key priorities for implementation) and NICE clinical guideline 10 recommendations 1.1.6.1-1.1.6.3.

Data source

Structure

a) Local data collection

Process

a) and b) Local data collection. The process measures will also be included in the National Diabetes Foot care Audit from 2013.

Outcome

a) The National Centre for Health Outcomes Development measures admissions to hospital of patients with diabetes where a lower limb amputation is undertaken. The National Diabetes Audit collects data on amputation rates.

Further structure and process data is being developed within the pilot phase of the new National Diabetes Foot care Audit and full implementation is planned within National Diabetes Audit 2 from 2013. Available from www.ic.nhs.uk.

Definitions

NICE clinical guideline 10 recommendation 1.1.8.1 defines “a foot problem requiring urgent medical attention” as:

  • new ulceration (wound)
  • new swelling
  • new discolouration (redder, bluer, paler, blacker, over part or all of foot).

These clinical features may indicate ulceration, infection or ischaemia or charcot arthropathy. People with these features should be referred and treated by a multidisciplinary foot care team within 24 hours. Treatment encompasses an assessment and clinical management as appropriate by the multidisciplinary foot care team (e.g., specialist wound care, debridement, treatment of infection).

NICE clinical guideline 119 recommendations 1.2.3 and 1.2.4 state that the multidisciplinary foot care team should consist of healthcare professionals with the specialist skills and competencies necessary to deliver inpatient care for patients with diabetic foot problems and should normally include a diabetologist, a surgeon with relevant expertise in managing diabetic foot problems, a diabetes nurse specialist, a podiatrist and a tissue viability nurse, and should have access to specialist services.

Foot problems requiring urgent medical attention will be managed in accordance with NICE guidance if treatment follows NICE clinical guideline 10recommendations 1.1.6.1-1.1.6.11 and 1.1.7.1 and NICE clinical guideline 119 recommendations 1.1.11-1.1.40.

This page was last updated: 13 July 2012

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.