Shared learning database

Podiatry Department. Bridgewater Community Health NHS Trust
Published date:
January 2013

Reinforce the North West Peripheral Arterial Disease Guidelines throughout the Podiatry Department. Presentation and workshop on implementing the Guidelines to improve patient care and outcomes.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

To update and reinforce existing knowledge of Lower Limb Peripheral Arterial Disease through out the Podiatry department in the Bridgewater Community Health NHS Trust.

I organised a study day for our department that focussed on the North West Peripheral Arterial Disease Guidelines.

A work shop was used after a presentation by Martin Fox vascular specialist podiatrist so that staff could be familiar with using the doppler. Most staff were already familiar with using the hand held doppler but our speaker Martin Fox encouraged staff to palpate and listen to, not just the dorsalis pedis and posterior tibialis pulses but to also to the popliteal and femoral pulses, so that we were not just working in our "comfort zone" but providing a more thorough examination of the lower limb.

Laminated copies of the Peripheral Arterial Disease (PAD) Integrated Care Pathway were given to each member of staff.

Evaluation sheets of the study day identified the need for more training around this area and that is what is currently happening. The less experienced staff shadow a more experienced member of staff who carry out ankle brachial pressure indices as a meaans of diagnosing Periheral Arterial Disease.

Staff are more confident in diagnosing Peripheral Arterial Disease (PAD) in their patients.

Early diagnosis of PAD ensures that any interventions needed by the patient are implemented as soon as possible so that the patient is receiving the best care possible. Limbs are saved and Coronary Heart Disease can be managed improving the general health of the patient.

Reasons for implementing your project

Some staff were referring patients inappropriately for ABPI's (ankle brachial indices)believing that their patient had peripheral arterial disease.

Appointments on the ABPI clinics were wasted as a result of this.

Staff who had referred inappropriately were less likely to refer future patients.

Patients were not getting the correct referral for their condition eg perhaps they needed to be referred for nerve pain which was being confused with Intermittant Claudication. Part of the study day encouraged staff to use the Edinnburgh Claudication questionaire when diagnosing Intermittant Claudication as it is 99% accurate.

Cost savings are made as appointments are not wasted.

Staff that are trained are more efficient in diagnosing Lower Limb arterial Disease.

Benefits include staff carrying out best practice in implementing the Guidelines.

This improves the patient outcomes for the patient which is what we are all ultimately aiming for.

Referrals are now more appropriate and increased as staff are more confident in diagnosing lower limb peripheral arterial disease.

How did you implement the project

The project was " Organising a study day for the department focussing on Lower Limb Arterial Disease and woundcare"

Although all staff have had the NICE guidance sent to them via internal e mails and they know where to find the Guidelines-on the NICE website we are bombarded continually with information.

The guidelines are relevant in every day practice and my intention was for our department to be more aware of the guidelines with a more detailed study of the guidelines by listening to a presentation and then carrying out the practical aspects (using the dopplers)in an informal setting so that staff that were unfamiliar with using the equipment would feel comfortable in using the dopplers perhaps as they hadn't done before i.e listening to the popliteal and femoral pulses of a colleague is less stress ful than doing it for the first time on a patient.

The project cost was approximately £350 pounds plus the whole day/half day or part day cost of the staff that attended the study day.

A medical company did pay for the cost of the venue (£100) and the buffet lunch (approx £250)

Laminating of literature was also bourne by the medical company.

The study day information is available to Podiatry staff on our shared drive at work and individuals were also given a pack of literature and e mailed pre and post course information.

Staff then use the training and information given in every day practice when treating their patients.

Key findings

Patient care-improved outcomes, early diagnosis of PAD and Coronary Heart disease means that a patient can be treated earlier improving their quality of life.

Cost savings are made as there are not as many inappropriate referrals. Quality of patient care is improved because of the increased knowledge of the Podiatrist, earlier diagnoses are made, earlier treatments are implemented improving the health of the patient and perhaps preventing amputations of the lower limb and complex heart operations.

Progress and outcomes are ongoing and difficult to measure e.g prevention of amputation of the lower limb due to a femoral popliteal bypass.

Equality and Diversity is important to our department and precourse information to staff included any barriers to learning that would cause a problem to staff on the day so that specific issues could be addressed

As the Society of Chiropodists and Podiatrists Union Learning Representative for our department I did write up the study day which was published in our Monthly Podiatry Journal. As a result of this the study day was read by Podiatrists nationally and the speaker Martin Fox has had several invitations from Podiatrists both in the NHS and from the private sector to speak on Peripheral Arterial Disease which is good as the message to reinforce the Peripheral Arterial Disease Guidelines have not just been presented to our department at Bridgewater but to all members of the Society of Chiropodists and Podiatrists nationwide both in the private sector and in the NHS.

Key learning points

-Include in the work shop how to perform an ankle brachial pressure indices on a patient in the work shop.
-Increase the workshop time so that more "hands on" is achived by the staff.
-Perhaps include a patient experience from different patients that have had differing outcomes from lower limb disease.
-Schedule shadowing opportunities for staff on the day to continue the learning experience.

Contact details

Nicola Skitt
Community Podiatrist
Podiatry Department. Bridgewater Community Health NHS Trust

Primary care
Is the example industry-sponsored in any way?

BSN medical company paid £350 for the full day hire of the training room and buffet lunch for the delegates (approximately 50 including speakers and medical representatives). BSN also laminated 4 A4 sheets of information for each delegate.