Diabetes patients praise care at The Princess Alexandra Hospital
Good foot care is a major factor in preventing complications from diabetes, and clinicians at The Princess Alexandra Hospital Trust (PAHT) have been expanding their foot care clinics, both in the hospital and in the community. The service has contributed to a high satisfaction rating from diabetes patients at the hospital. During the week when the spotlight is on prevention of diabetes, foot care nurses and podiatrists have been urging patients to put their feet first.
Blood vessel (vascular) damage associated with diabetes can intensify foot problems, which in some cases lead to amputation. The specialist foot care (Multidisciplinary Diabetic Footcare Team (MDFT) clinic has already seen benefits in the two years since its introduction at the trust - bed stay has reduced and amputation rates improved. It is among the services that have led to the high satisfaction rate in a recent survey, which showed that the majority of the Harlow hospital's patients are satisfied or very satisfied with the care of their diabetes.
Diabetes prevention week this week, (1-7 April), is a good time to remind patients of ways to limit the illness. Clinicians at the hospital, including dieticians and vascular nurses, work throughout the year to help patients to manage their condition and prevent deterioration. But as feet can be a key sign of problems, they have been extra keen to remind patients they should have an annual foot check at their GP surgery as part of their diabetic review to ensure good blood glucose levels.
The foot care service is a part of the multi-disciplinary foot care team at PAHT which includes dieticians, vascular nurses and consultants and other clinicians.Diabetes can cause damage to the blood vessels (vascular system) which restricts blood flow - a cause of foot wounds. The integrated services mean there can be early review of patients who are either admitted to hospital or referred to a clinic with diabetic foot problems. The service works in conjunction with the community GPs, practice nurses and community podiatrists, and staff members rotate to the community and back to the trust for more integrated care. The review checks pulse - to ensure good blood supply - and includes a neurological test to ensure intact sensation, and a skin inspection to check there are no breaks in the skin or deformities to the foot.
Dr Dev Sennik, diabetes and endocrinology consultant at the hospital, explained how the foot service fits into the diabetes service: "Working as a team we have been able to provide education to patients on improving blood glucose control and managing their diet and lifestyle. This helps to improve wound healing and prevention of worsening complications. We also work with the vascular team to ensure appropriate surgical management to improve blood supply where needed".
If a diabetic patient is admitted to the emergency department, a diabetes nurse will automatically carry out a foot examination. One way to detect these problems, is an examination by vascular nurses who use an instrument called a doppler - which uses ultrasound to measure blood flow. If a problem is noticed patients are treated and referred to the local community podiatrist.
In the West Essex region approximately 20,000 patients have diabetes. Of these 90% have Type 2 diabetes, which is related to lifestyle and diet. A numbeof people with complex issues will be seen regularly in hospital - approximately 500 per year - before being discharged back to the care of community services. As many as 85% of diabetes related amputations are precipitated by a foot ulcer.
Heidi Sheppard, diabetes specialist podiatrist at PAHT, said: "Poorly controlled diabetes can lead to loss of feeling, poor blood supply and deformity of the foot.
As patients injure their feet due to lack of feeling, or burns and blisters. this can lead to longstanding wounds which deteriorate and infections can lead to needing minor and major amputation - so we would really encourage patients to get their feet checked regularly .
We are very pleased to be able to offer this essential care and are proud that feedback from our patients shows their satisfaction with the diabetes care they receive is very positive."
Facts and figures
Diabetes is a global concern and is expected by 2030 that 8.3% of adult population will have the disease (Bakker et al.2012)
Diabetes remains the most common cause of amputation in people of working age, accounting for 20-40% of all lower extremity amputations.
Diabetic foot infections (DFI) cause a limb to be lost every 20 seconds (Lipsky et al.2012)
In th UK there are 64,000 active foot ulcers at one time (Gordois et al . 2003)
Foot ulcers lead to amputation and amputation is associated with a 5 year mortality rate (Armstrong et al.2007)
£650million or £1 in every £150 spent in the NHS is on foot ulcers and amputations
85% of diabetes related amputations are precipitated by a foot ulcer.
People with DFU experience reduced quality of life in terms of restricted mobility, reduction in social activities, and time lost from work.
The personal, social, psychological and financial impacts of diabetic foot ulceration are considerable.