Audrey Xie, BPodM Podiatrist e: audreyzxie@gmail.com INTRODUCING THE DIABETIC FOOT ASSESSMENT FORM ON MMEX (E-HEALTH PLATFORM) 31st October 2013 Audrey Xie, BPodM Podiatrist e: audreyzxie@gmail.com

BACKGROUND – MMEX1 E-health platform Provided by the UWA Center for Software Practice

BACKGROUND – MMEX1 Pros: Cons: Small annual fee of $250 (FREE for Department of Health) Ease of use – patient notes, alerts, reminders, calendar No physical storage Attachment of photos, documents, letters, forms Secure database Safe and confidential communication with health professionals and hospitals (including tertiary hospitals) Cons: Not all health professionals in the Wheatbelt are aware of it or are using it

A KEY CHALLENGE – FOOT ULCERS Foot ulcers can be detrimental Poor blood glucose control Neuropathy and/or microvascular disease Foot ulcers Wound infection Osteomyelitis Amputation Systemic infection Death A key challenge we have found working in the Wheatbelt region – being able to identify the risk of foot ulcers and knowing how to prevent and manage them A major area of improvement, which we believe with the help of all primary health providers, can be achieved

STATISTICS & FIGURES Cost to the patient and the health department 5-year mortality rates for diabetes amputations are 50% (twice that of cancer)2 Each amputation costs $26,000 to the health department2 An area for improvement – it can be achieved

NATIONAL EVIDENCE-BASED GUIDELINES: PREVENTION “85% of diabetes amputations are entirely preventable”3 Identify patient’s risk “Assess all people with diabetes and stratify their risk of developing foot complications”4 Regular foot assessments “Any suitably trained healthcare professional may perform the risk assessment”4 3 multi disciplinary foot care team in Perth – Royal Perth, Sir Charles Gairdner and Fremantle Hospitals

NATIONAL EVIDENCE-BASED GUIDELINES: MANAGEMENT “Pressure reduction optimises healing of foot ulcers”4 “People with diabetes-related foot ulceration are best managed by a multi-disciplinary foot care team”4 Deep ulcers (probe to tendon/bone) 4 weeks’ duration Absence of foot pulses Ascending cellulitis Suspected Charcot’s neuroarthropathy

USING THE DIABETIC FOOT ASSESSMENT FORM ON MMEX Formulated by Deborah Schoen Universal form for all diabetic foot assessments Evidence-based Available on MMEx for all users Able to attach completed forms to patient record Easy to use & risk is automatically calculated 5 essential components Current foot ulcer History of amputation/foot ulcer Foot deformity Palpation of foot pulses Presence of protective sensation

1. CURRENT FOOT ULCER 2. HISTORY OF AMPUTATION/FOOT ULCER If any “Yes” is checked, patient is immediately classified as High Risk

3. FOOT DEFORMITY If 3 or more “Yes”, patient is considered to have a foot deformity

4. PALPATION OF FOOT PULSES If 3 or more “+” , patient is considered to have palpable foot pulses

5. PRESENCE OF PROTECTIVE SENSATION As long as 1 site is “-”, patient is considered to have no protective sensation

RISK FACTOR 12 months 6 months 3 months

CONCLUSION As a primary health professional, you can help to: Identify ulcer risk Conduct a foot check every 3/6/12 months Encourage pressure relief Refer to Podiatrist or multidisciplinary foot care team

TAKE-HOME MESSAGE “A foot ulcer is serious…”3 – help to prevent it!

REFERENCES UWA CSP. MMEx [Internet]. Perth, WA (Australia): MMEx; 2013 [updated 2013 Aug 21; cited 2013 Oct 20]. Available from: http://www.mmex.net.au Australasian Podiatry Council. Diabetic Amputations in Australia. Brunswick East (VIC): Australasian Podiatry Council; 2013 Oct. 85 per cent of diabetes amputations "entirely preventable”. Diabetes WA [Internet]. 2012 Aug 31 [cited 2013 Oct 20]; Diabetes WA News. Available from: http://www.diabeteswa.com.au/News_and_events/Diabetes_ WA_News/News_Details/85_per_cent_of_diabetes_amputatio ns National Evidence-Based Guideline on Prevention, Identification and Management of Foot Complications: Part of the Guidelines on the management of Type 2 Diabetes [Internet]. Melbourne: National Health and Medical Research Council; 2011 [cited 2013 Oct 20]. Available from: http://www.nhmrc.gov.au/_files_nhmrc/publications/attachm ents/diabetes_foot_full_guideline_23062011.pdf