Download Wessex Foot Care Quality Standards

Wessex Cardiovascular Clinical Network
Foot Care
Quality Standards
Amputation is one of the most feared complications of diabetes yet many are preventable.
Amputations reduce quality and quantity of life. Reducing the number of amputations among
people living with diabetes in Wessex has been a key aim of the Wessex Cardiovascular Clinical
Network. The network is delighted to have supported the development of the Wessex quality
standards for diabetic foot care. These standards set out the care that people with diabetes and
foot disease should expect to receive and that commissioners and providers should strive to provide.
The implementation of the standards across Wessex aims to reduce variation in care and improve
outcomes for people with this distressing condition.
Dr Hermione Price
Wessex Diabetes Clinical Lead
Tier 1 Primary Care
Ref
Quality Standard
Metric
Data source options
P1
All practice patients with diabetes will have an
annual foot check and will be classified according to
risk of foot ulceration.
9 care processes
QOF or local system
Note: Plans for foot checks must be established
irrespective of where patients live i.e residential
care, prison, etc. Exclusions should be highlighted.
% of patients with a record
of foot exam (pulses and
neuropathy testing) in last
12months and foot classified
as: low; increased/moderate;
high risk or ulcer present
P2
Every person receiving a foot check should be
informed of their foot risk status.
% of patients aware of
ulceration risk
Local patient
survey/evidence
of appropriate
information given
P3
Every person receiving a foot check should be
offered appropriate education, including written
information relevant to their risk of foot ulceration.
% of patients offered
appropriate education
Patient survey/local
audit
P4
All healthcare professionals undertaking foot checks
should have attended a competency update within
the previous 2 years.
% of practices that have
appropriately trained
personnel
Practice education
plan. Education
provider record
P5
Every person identified as being at moderate or
high risk must be referred to the Foot Protection
Service (FPS).
% of at risk patients referred
to FPS
Practice profile and/
or referral data
Tier 2/3 Community Foot Protection Service (FPS)
Ref
Quality Standard
Metric
Data source options
C1
Patients with diabetes who are house-bound or in
residential care homes should have an equivalent
level of access to foot protection.
Evidence of local activity by
site
Provider data
% of residential care residents
with diabetes under the care
of the FPS or Multidisciplinary
Foot Service (MDFS)
Local audit
Those people at moderate or high risk of foot
ulceration should be under the care of the FPS.
% of patients at moderate/
high risk attending the FPS
Provider data
C3
The FPS will be coordinated by a named podiatrist
who will have appropriate skills and experience.
Named clinician and contact
details known across pathway
Pathway information
and job role
C4
All moderate/high risk patients should be able
to access the FPS within NICE Guideline NG19
timescales*.
% of patients seen within
NG19 timescales
Provider data
C2
Local audit
Local audit
*NG 19 and 24hrs are guideline targets. Commissioners and providers should be working towards these and benchmark current wait times.
Tier 4 Hospital Inpatient and Multidisciplinary Foot Service (MDFS)
Ref
Quality Standard
Metric
Data source options
M1
A MDFS should be available for those with a foot
care emergency.
Evidence of commissioned
service
Review of local
care pathway and
specification
M2
A named consultant should be accountable for the
overall care of the MDFS.
Named clinician and contact
details known across pathway
Pathway information
and job role
M3
A clear referral pathway to the MDFS should be
widely available (paper and electronic).
Evidence of local pathway
Review of local care
pathway
M4
All patients who develop a foot care emergency
Time between initial
should be reviewed promptly by the MDFS team and assessment by HCP and review
within 24hrs*.
by MDFS
National diabetes
foot ulcer audit
M5
Each hospital should have an inpatient foot care
pathway for all people with diabetes.
Inpatient podiatrist post
Service specification
Compliance with national
audit and evidence of local
pathway
National Diabetes
Inpatient Audit
% of patients with hospital
acquired infections and/or
pressure ulcers to heels in
inpatients with diabetes
Local audit
M6
FPS and MDFS should be able to provide
patients with the evidence-based interventions
recommended by the NICE CG19 guideline.
% of patients with access to
evidence based interventions
e.g. contact casting
Exception reporting
M7
All patients with diabetes undergoing lower limb
amputation should be reviewed both pre- and postoperatively by the specialist diabetes team.
% of patients reviewed by
diabetes MDT pre- and postamputation
Provider data and
local audit
M8
For patients requiring amputation each should have
an individualised plan considering their medical
needs and social circumstances to maximise clinical
outcomes.
% of patients with post
surgical personalised care plan
Provider data and
local audit
Quality Improvement Actions required by CCGs
Ref
Quality Standard
Metric
Data source options
Q1
CCGs to require providers to produce robust plans
for root cause analysis (RCA) for amputations.
Completed RCAs as a total
number and % of all diabetes
related amputations
Evidence of RCA
reports completed
Q2
CCGs to require providers to respond to the
National Diabetes Foot Care Audit and National
Diabetes Inpatient Audit.
Completed audit returns
Evidence of
submission to
national audit
programme
Q3
CCGs to set target for reduction ambitions for the
number of major and minor amputations.
Number of amputations and
rate per 1000 people with
diabetes
National diabetes
foot care profiles
Q4
CCGs to set targets for reduction ambitions for
hospital nights stay and episodes of care associated
with diabetic foot complications.
Number of hospital nights stay National diabetes
and episodes of care
foot care profiles
Bibliography and further information
• P utting Feet First: Diabetes UK position on preventing amputations and improving foot care for people with diabetes;
Diabetes UK, October 2015.
• Diabetic Foot Problems, Prevention and Management; National Clinical Guideline 19; NICE; August 2015
• G
uidance documents on prevention and management of foot problems in diabetes: development of an evidence-based
global consensus; The International Working Group on the Diabetic Foot (IWGDF); 2015
• 2016/17 General Medical Services (GMS) contract Quality and Outcomes Framework (QOF), NHS England, April 2016
• Diabetes foot care activity profiles, Public Health England, August 2016
• National Diabetes Foot Care Audit, NHS Digital, March 2016
• National Diabetes Inpatient Audit, NHS Digital, June 2016
Wessex Clinical Networks: www.wessexscn.nhs.uk
Clinical Senate: www.wessexsenate.nhs.uk
Published:
November 2016
Review date: November 2018
“Working together for lifelong quality care”
CS43921 – NHS Creative – November 2016