The DIAFOOT Project: developing and implementing an evidence based acute diabetic foot care bundle Dr Nida Chammas Clinical Lead DIAFOOT project NIHR CLAHRC NW London February 2014

N Chammas

Background 15% of diabetic patients will develop a diabetic foot ulcer Lifetime risk is 25%

20% of diabetic admissions to hospital due to foot problems Total expenditure on inpatient care for foot ulceration and amputation in 2010–11 is at £257 million. 11

Diabetic foot ulcers precede >80% of amputations in Diabetic patients (100 people per week)

Mortality DFU patients have 2.4 times the mortality rate of non-ulcerated diabetic patients.

Financial Impact £700 million per year in England

E Ramhamadany

DIAFOOT Project £104,000 Nida Chammas Khalid Ahmed Professor Edmonds Essam Ramhamadany Sandra Wilson CLAHRC NICE

£104,000 THE DIAFOOT PROJECT funded by NIHR CLAHRC NW London

AIM To implement the current national guidelines for inpatient management of acute diabetic foot problems NICE guidelines 2011 Diabetes UK ( Putting Feet First)2009

Sandra Wilson

Diabetic Foot care bundle Nida Chammas Junior Drs Dan Brown Patients Essam Ramhamadany Sandra Wilson CLAHRC Team Khalid Ahmed Elaine Hui

C Stacey

N Chammas

Results Implementation for 60 consecutive weeks (December 2011 to January 2013) 991 patients screened 254 (25.6%) identified as potential DF disease. 99 (38.9%) patients assessed by a doctor. 50% of patients had signs of ulceration; 43% had at least two or more signs of DF

Summary Approximately one thousand patients were screened and nearly 1 in 10 patients identified as positive for acute DF disease were assessed by a doctor. This demonstrates that a significant proportion of admissions were influenced by this quality improvement project.

Conclusion The DIAFOOT project represents a service improvement model, promoting new strategies for implementation of evidence- based practice.