Podiatry Diabetes Update 2014 Keith Hilston Lead Specialist for Diabetes and Wound Management

Content Putting Feet First Annual Foot Check Community Foot Protection Teams (CFPTs) Multidisciplinary Foot Team (MDfT) Data

Care Process - Foot examination Year of auditEngland %Berkshire West % * National Diabetes Audit

Percentage of patients receiving DM29 by practice QOF QOF

Education Urgent referral to Podiatry Refer to Podiatry Basic patient education A neuropathy B vascular C deformity D other Inform patient risk rating

Foot Risk-Why important

Podiatry Berkshire West

Risk of ulceration 99.6% ulcer free after 2 years Patients with active foot disease Patients with a history of diabetic foot disease: risk of reulceration 40 – 50% per year. Patients with established risk factors for diabetic foot disease: risk of ulceration 3 – 7 % per year. Basic patient education A neuropathy B vascular C deformity D other Inform patient risk rating 70 % 20 % 4-8 % 1-4 % (1097) 680 – 1360 (849) 170 – 680 (542)

Out-patient clinics Daily woundcare clincs (95% diabetes, other – vascular, RA, renal) Weekly MDT (diabetologist lead, no other direct input) Other – monthly Radiology/Renal MDTs, footwear assessment clinic In-patients Daily referrals woundcare (90% diabetes), other foot pathologies Think Glucose / NICE 119 Royal Berkshire Hospital Clinic2012/122013/14 Acute Radiology MDT4025 Acute Diabetic Foot Clinic Acute Footwear Assessment4836 Acute Ward Acute Woundcare Totals

Year Admitted with foot disease England 20105%9.4% %9.1% %9.2% %9.1% Year Foot risk assessment during first 24 hours of hospital stay England %23.7% %22.3% %29.9% %37.6% In-patient Care NaDiA data

In-patient Referrals

In-patient episodes of care

In-patient bed days NW S N W

Outcome measures

The National Diabetes Audit is expanding to cover: Diabetes footcare This audit will cover the structures, processes and outcomes of foot care services for people with diabetes. The audit is currently being developed following a pilot by NHS Diabetes and is expected to be handed over to the NDA for national roll out in National Diabetes Audit

14 Pilot sites, >490 new ulcers (baseline data only) National Diabetes Audit

Quality of foot screening needs auditing Unidentified patients with foot risk in community Supporting specialists for MDfT (surgeons – vasc/ortho) Vascular pathway (waiting times - imaging/procedures) Unified diabetes budget across care boundaries IT systems aligned/information sharing Summary