Bucks Putting Feet First Inpatient Service - TVSCN

Bucks Putting Feet First Inpatient Service Erin Lee Clinical Lead Podiatrist Bucks Integrated Podiatry Service General Podiatry clinics Based in Community Aims Of Our PFF Inpatient Service Recommendation Routine basic assessment and care of the diabetic foot within 48 hours of admission. Expert assessment and management of existing

ulcer/Charcot Education for patient. Prevention of new onset foot disease in patients admitted to hospital for unrelated reasons. Education for ward staff. Hospital sites Stoke Mandeville Hospital Beds 545: Medical, Surgical, Spinal and women and children 36,956 Non elective admission.

Wycombe General Hospital Beds 121: Cardiac, Stroke, surgical Urology and ITU. Amersham General Hospital Beds 63: Rehabilitation Case For Change NICE Guideline 119 (2011) National diabetes Inpatient audit. Bucks in 2013 Keogh Action plan and the Keogh Rapid response review Report.

Relevant Departments Engaged Meeting with: Dr S Gardner - Lead Diabetic Consultant, Morag Thomson AHP / Therapy Lead community division Podiatry service manager, Podiatry clinical Lead How would this service work? Nurses on ward Nursing issues in Keogh report - Capacity Educate ward staff -costly Started process in 2012 Nov 2012 band 6 podiatrist was release from duties to complete a pilot. For 1 week at one site SMH

Developed a screening tool to be used on ward with PFF guide as an aid. Kit included Locate which patients have diabetes. 15 Wards visited and 37 Patient with diabetes identified. Results presented at board level with first draft business case. Sept 2013 next pilot Funding for locum Podiatrist enabling podiatry to under

take 12 months pilot at all 3 Hospital sites. Sept 2013 July 2014 National Diabetes Inpatient Audit reflected this positively: Patient that received a foot risk assessment during stay? 2011 8.5% 2012 4.4% 2013 42.3% 2015 13.2% Limitation to the service

Duplication of patients screened Multiple Podiatrist performing screening Lack of good Communication Patient were not screened within 48 hours Identifying which patient are diabetic on the wards Follow up for those identified as High and Active Risk Patient with active foot - Capacity Patient living outside area Increase in admin Next business case more informed 2 WTE Band 3 Podiatry assistants 2 WTE Band 6 Podiatrist Equipment needed

Jan 2015 Business case signed off Recruitment of Band 3 Podiatry assistance and Training package.

2 weeks observing Observe DEG talks all 4 sessions for an over view of diabetes Observe 2 High risk Community Clinics High risk patients Observe Ulcer clinics Observe MDFT clinic 2 Whole day Theory training Why are we doing PFF Overview of how the service will look What type of patient will we be screening and why Overview of circulation including practical checking foot pulses palpating and with doppler Overview of neurological 10g Monofilament Including practical session Noting deformities Ulceration signs and symptoms Terminology and abbreviations Anatomy How to classify a diabetic patient according to PFF Leaflets and education Out coming patient Registering on RIO and follow up appointment Half day session with Frances Registering patients on RIO Assigned a Band 6 Mentor to each FCA the FCA will then be asked to check foot pulses and neurological status

of each patient attending clinic with their Mentor supervision. Also entering this information onto the RIO notes. The FCA will then have competencies signed off. Ward visits Each FCA will be accompanied to wards: gaining confidence and protocol for attending ward Band 6 Podiatrist Training program 2 weeks observing Observe DEG talks all 4 sessions for an over view of diabetes Observe 2 High risk Community Clinics High risk patients Observe Ulcer clinics

Observe MDFT clinics and then participating 10 week Ulcer clinic placement at SMH and WGH Competencies lead training Certificate in Diabetes What's involved: Band 3 Assistance: Screening tool Education leaflets Outcome letter to GP Built in Audit Admin - Registering Follow up podiatry care if required in appropriate Clinic.

Current situation Service started Jan 2016 Data collected from Jan Oct 2016 Hospital Site SMH WGH AGH Total Number of patient screened

278 362 63 703 Break Down of Risk Rating Risk SMH WGH AGH Total (%) Active Foot 59 30

12 101 (14%) High Risk 49 46 8 103 (15%) Moderate Risk 99 152 27 278 (40%)

Low Risk 62 125 16 203 (29%) Declin/Bilat 9 9 0 18 (2%) Total 278

362 63 703 Not known to Podiatry No Active open referral in past 6 months. Data only from SMH and AGH No of Patients Total % Active Ulcer /Charcot 25 35%

High Risk 28 49% 24 Patients with active Foot ulcer Not known our Podiatry Service 13 Male 11 Female 54% of patient over 80 (Ranging 46 97) 14 patient lived in south of county, 8 Live in North county and 2 Live out of area. 4 Patient live in Nursing Home.

8 patient had pass away within 3 months of screening. 7 Patient were described as having pressure ulceration. 2 Patient went on to have minor amputation. 2 Patient went on to have major amputation. Ever Evolving Service Limitation: Identifying diabetic patient on wards. Not yet achieving our target of screening within 48 hours.

Introduce Root Cause Analysis to MDFT. PFF Inpatient ward round with Diabetes team. Rota for all Band 6 Podiatry staff to be involved in PFF Inpatient. Education program for ward staff. Work along side TVN to prevent hospital acquired pressure in feet. Thank You