Enhancement of Diabetic Foot Ulcer Management in O&T PYNEH

Abstract Description

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Authors (including presenting author) :

Cheung SSS(1), Cheng YCA(1), Ho MW(1), Yung KT(1) and Mok LC(1)

Affiliation :

(1)Department of Orthopaedics & Traumatology, Pamela Youde Nethersole Eastern Hospital

Introduction :

Diabetic foot ulcer (DFU) represents a leading cause of hospitalization and non-traumatic limb amputation among patients with diabetic mellitus (DM). Structural health care assessment and practical clinical guideline are equally important for reducing diabetic foot amputations. In order to maximize the outcomes of DFU patient, it is crucial to enhance nurses’ competence in performing DFU assessment and increase their knowledge in delivering related care.

Objectives :

(1)To standardize diabetic foot ulcer management (2)To enhance professional knowledge on DM foot assessment and ulcer management (3)To ensure continuity of care for DFU patients

Methodology :

A new multidisciplinary departmental management guideline was implemented in 2017 in Pamela Youde Nethersole Eastern Hospital (PYNEH) with the aim to streamline the management flow of DFU patients. In corresponding with the changes, 2 identical in-house training workshops were conducted to enhance Orthopaedics and Traumatology (O&T) nurses’ knowledge and competence in diabetic foot assessment and ulcer management. By using the “DM Foot Initial Assessment Form” which endorsed by Specialty Advisory Group (O&T), trained O&T nurses provided 1st tier foot assessment and wound management for DFU patients. All DFU patients were also reviewed by a designated nursing team. The team consistently managed and followed-up patient’s problem(s) in accordance with the guideline. The nursing team acted as patient advocate, referred patients to parties concerned for early interventions if problems were detected during the treatment journey.

Result & Outcome :

2 identical in-house training workshops were conducted. There were 43 O&T nurses in PYNEH participated in the trainings. From February 2017 to December 2018, there were 122 DFU patients admitted to O&T/PYNEH. All patients received the new diabetic foot assessment and managed in accordance with the guideline. For patients with newly diagnosed DM or poorly DM control, 79% were referred to diabetic nursing service while 88% were referred to dietitian. For medical management, 68% of the patients were referred to medical specialty and 72% of the patients with suspected vascular insufficiency were referred to vascular team. 90% of the patients were able to save their limbs and could be discharged timely with early follow-up in the O&T nurse clinic. The program illustrated that (1) structural initial foot assessment; (2) proper wound management and (3) timely referral to concerned multidisciplinary parties can enhance the limb salvage rate and shorten the length of stay amongst DM foot patients. Nurse, as an important carer of DFU patients in hospital, should pay effort to maximize patient outcomes through such practice.