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'At risk' foot

Quality statement

People with diabetes at risk of foot ulceration receive regular review by a foot protection team in accordance with NICE guidance.

Quality measure

Structure

a) Evidence of local arrangements to ensure that people with diabetes at risk of foot ulceration receive regular review by a foot protection team in accordance with NICE guidance.

Process

a) Proportion of people with diabetes at risk of foot ulceration who receive regular review by a foot protection team in accordance with NICE guidance.

Numerator - the number of people in the denominator who receive regular review by a foot protection team in accordance with NICE guidance.

Denominator - the number of people with diabetes at risk of foot ulceration.

Outcome

a) Incidence of foot ulceration.

b) Rates of lower limb amputation.

Description of what the quality statement means for each audience

Service providersensure access to appropriate treatment and review by a foot protection team for people with diabetes at risk of foot ulceration in accordance with NICE guidance.

Healthcare professionals ensure they identify and manage people with diabetes at risk of foot ulceration in accordance with NICE guidance.

Commissioners ensure they commission services that provide access to regular review by a foot protection team for people with diabetes at risk of foot ulceration in accordance with NICE guidance.

People with diabetes who are at risk of developing foot ulcers have regular check-ups from a team specialising in foot protection.

Source clinical guideline references

NICE clinical guideline 10 recommendations 1.1.4.3, 1.1.5.2, 1.1.5.3, 1.1.5.4, 1.1.5.5 (key priorities for implementation), 1.1.4.1 and 1.1.5.1.

Data source

Structure

a) and b) DiabetesE collects data on foot services.

This will also be included in the National Diabetes Foot care Audit from 2013.

Process

a) Local data collection. Quality and Outcomes Framework (QOF) DM 9 The percentage of patients with diabetes with a record of the presence or absence of peripheral pulses in the previous 15 months. QOF indicator DM 10 The percentage of patients with diabetes with a record of neuropathy testing in the previous 15 months.

Outcome

a) Local data collection.

b) 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 the National Diabetes Audit 2 from 2013. Available from www.ic.nhs.uk.

Definitions

NICE clinical guideline 10, recommendation 1.1.2.4 classifies risk of foot ulceration as follows:

  • low current risk (normal sensation, palpable pulses)
  • at increased risk (neuropathy or absent pulses or other risk factor)
  • at high risk (neuropathy or absent pulses plus deformity or skin changes or previous ulcer)

People with diabetes at risk of foot ulceration who require regular review by a foot protection team are those in the "increased or high risk" categories.

NICE clinical guideline 10, recommendation 1.1.4.1 defines a ‘foot protection team' as a team with expertise in protecting the foot, typically including podiatrists, orthotists and foot care specialists.

Regular review will be in accordance with NICE guidance if it follows NICE clinical guideline 10 recommendations 1.1.4.1-1.1.5.5.

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.