1. 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

2. N Chammas

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

4. 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

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

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

7. Financial Impact £700 million per year in England

8. E Ramhamadany

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

10. £104,000 THE DIAFOOT PROJECT funded by NIHR CLAHRC NW London

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

12. Sandra Wilson

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

16. C Stacey

21. N Chammas

22. 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

23. 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.

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