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Diabetic foot problems: prevention and management [NG19]

Measuring the use of this guidance

Recommendation: 1.1.3

Refer the person to the multidisciplinary foot care service within 24 hours of the initial examination of the person's feet. Transfer the responsibility of care to a consultant member of the multidisciplinary foot care service if a diabetic foot problem is the dominant clinical factor for inpatient care.

What was measured: Proportion of people with diabetes who received a diabetic foot risk assessment within 24 hours of admission to hospital.
Data collection end: September 2012
30.1%
Data collection end: September 2013
37.5%
Data collection end: September 2015
28.7%
Area covered: England
Source: Health and Social Care Information Centre. National Diabetes Inpatient Audit.


Recommendation: 1.2.1

Commissioners and service providers should ensure that the following are in place: • A foot protection service for preventing diabetic foot problems, and for treating and managing diabetic foot problems in the community. • A multidisciplinary foot care service for managing diabetic foot problems in hospital and in the community that cannot be managed by the foot protection service. This may also be known as an interdisciplinary foot care service. • Robust protocols and clear local pathways for the continued and integrated care of people across all settings, including emergency care and general practice. The protocols should set out the relationship between the foot protection service and the multidisciplinary foot care service. • Regular reviews of treatment and patient outcomes, in line with the National Diabetes Foot Care Audit.

What was measured: Proportion of CCGs and local health boards providing a foot protection service pathway.
Data collection end: April 2015
77.4%
Area covered: England
Source: Health and Social Care Information Centre. National Diabetes Foot Care Audit.


Recommendation: 1.3.2

For young people with diabetes who are 12–17 years, the paediatric care team or the transitional care team should assess the young person's feet as part of their annual assessment, and provide information about foot care. If a diabetic foot problem is found or suspected, the paediatric care team or the transitional care team should refer the young person to an appropriate specialist.

What was measured: Proportion of children and young people aged 12 years or older who had a foot examination reported in the audit period.
Data collection end: March 2014
45.7%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: For young people with diabetes who are 12–17 years, the paediatric care team or the transitional care team should assess the young person's feet as part of their annual assessment, and provide information about foot care. If a diabetic foot problem is found or suspected, the paediatric care team or the transitional care team should refer the young person to an appropriate specialist.
Data collection end: March 2015
55.4%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people aged 12 years or older with diabetes who had a foot examination reported in the audit period.
Data collection end: May 2015
55.4%
Area covered: National
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people aged over 12 with type 1 diabetes with a complete year of care who had a foot examination in 2015/16.
Data collection end: March 2016
65.8%
Area covered: England and Wales
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.

What was measured: Proportion of children and young people aged over 12 with type 2 diabetes with a complete year of care who had a foot examination in 2015/16.
Data collection end: March 2016
50%
Area covered: England and Wales
Source: Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit.


Recommendation: 1.3.3

For adults with diabetes, assess their risk of developing a diabetic foot problem at the following times: When diabetes is diagnosed, and at least annually thereafter (see recommendation 1.3.11). If any foot problems arise. On any admission to hospital, and if there is any change in their status while they are in hospital.

What was measured: Proportion of patients with type 1 diabetes over 12 years old who had their feet examined in the last year.
Data collection end: March 2015
72.4%
Data collection end: March 2016
73.7%
Number that met the criteria: 136143 / 184820
Data collection end: March 2017
70.1%
Number that met the criteria: 144055 / 205530
Area covered: National
Source: NHS Digital. National Diabetes Audit.

What was measured: Proportion of patients with type 2 diabetes over 12 years old who had their feet examined in the last year.
Data collection end: March 2015
86.7%
Data collection end: March 2016
87.1%
Number that met the criteria: 1972306 / 2263118
Data collection end: March 2017
79.4%
Number that met the criteria: 2128980 / 2680030
Area covered: National
Source: NHS Digital. National Diabetes Audit.

What was measured: DM012: The percentage of patients with diabetes, on the register, with a record of a foot examination and risk classification: 1) low risk (normal sensation, palpable pulses), 2) increased risk (neuropathy or absent pulses), 3) high risk (neuropathy or absent pulses plus deformity or skin changes in previous ulcer) or 4) ulcerated foot within the preceding 12 months.
Data collection end: March 2015
81.52%
Data collection end: March 2016
81.45%
Data collection end: March 2017
82.44%
Area covered: National
Source: Health and Social Care Information Centre. Quality and Outcomes Framework.


Recommendation: 1.4.1

If a person has a limb‑threatening or life‑threatening diabetic foot problem, refer them immediately to acute services and inform the multidisciplinary foot care service (according to local protocols and pathways; also see recommendation 1.2.1), so they can be assessed and an individualised treatment plan put in place. Examples of limb‑threatening and life‑threatening diabetic foot problems include the following: • Ulceration with fever or any signs of sepsis. • Ulceration with limb ischaemia (see the NICE guideline on lower limb peripheral arterial disease). • Clinical concern that there is a deep‑seated soft tissue or bone infection (with or without ulceration). • Gangrene (with or without ulceration).

What was measured: Proportion of CCGs and local health boards providing a pathway for foot assessment within 24 hours.
Data collection end: April 2015
54.1%
Area covered: England
Source: Health and Social Care Information Centre. National Diabetes Foot Care Audit.


Recommendation: 1.4.2

For all other active diabetic foot problems, refer the person within 1 working day to the multidisciplinary foot care service or foot protection service (according to local protocols and pathways; also see recommendation 1.2.1) for triage within 1 further working day.

What was measured: Proportion of people with diabetes with an active foot problem (not self-presenting) referred to the multidisciplinary foot care service or foot protection service within one working day and triaged within one further working day.
Data collection end: April 2015
14.4%
Area covered: England
Source: Health and Social Care Information Centre. National Diabetes Foot Care Audit.



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