INTRODUCING THE DIABETIC FOOT ASSESSMENT FORM ON MMEX (E-HEALTH PLATFORM)

Audrey Xie, BPodM

Podiatrist

e: audreyzxie@gmail.com

31st October 2013

BACKGROUND – MMEX1

E-health platform Provided by the UWA Center for Software

Practice

BACKGROUND – MMEX1

Pros: Small annual fee of $250 (FREE for Department

of Health) Ease of use – patient notes, alerts, reminders,

calendar No physical storage Attachment of photos, documents, letters, forms Secure database Safe and confidential communication with health

professionals and hospitals (including tertiary hospitals)

Cons: Not all health professionals in the Wheatbelt are

aware of it or are using it

A KEY CHALLENGE – FOOT ULCERS

Foot ulcers can be detrimental

STATISTICS & FIGURES

Cost to the patient and the health department 5-year mortality rates for diabetes amputations are

50% (twice that of cancer)2

Each amputation costs $26,000 to the health department2

An area for improvement – it can be achieved

NATIONAL EVIDENCE-BASED GUIDELINES: PREVENTION

“85% of diabetes amputations are entirely preventable”3

Identify patient’s risk “Assess all people with diabetes

and stratify their risk of developing foot complications”4

Regular foot assessments “Any suitably trained healthcare

professional may perform the risk assessment”4

NATIONAL EVIDENCE-BASED GUIDELINES: MANAGEMENT

“Pressure reduction optimises healing of foot ulcers”4

“People with diabetes-related foot ulceration are best managed by a multi-disciplinary foot care team”4

Deep ulcers (probe to tendon/bone) 4 weeks’ duration Absence of foot pulses Ascending cellulitis Suspected Charcot’s neuroarthropathy

USING THE DIABETIC FOOT ASSESSMENT FORM ON MMEX Formulated by Deborah Schoen Universal form for all diabetic foot assessments Evidence-based Available on MMEx for all users Able to attach completed forms to patient

record Easy to use & risk is automatically calculated 5 essential components

1. Current foot ulcer2. History of amputation/foot ulcer3. Foot deformity4. Palpation of foot pulses5. Presence of protective sensation

1. CURRENT FOOT ULCER2. HISTORY OF AMPUTATION/FOOT ULCER

If any “Yes” is checked, patient is immediately classified as High Risk

3. FOOT DEFORMITY

If 3 or more “Yes”, patient is considered to have a foot deformity

4. PALPATION OF FOOT PULSES

If 3 or more “+” , patient is considered to have palpable foot pulses

5. PRESENCE OF PROTECTIVE SENSATION

As long as 1 site is “-”, patient is considered to have no protective sensation

RISK FACTOR

6 months

12 months

3 months

CONCLUSION

As a primary health professional, you can help to: Identify ulcer risk Conduct a foot check every 3/6/12 months Encourage pressure relief Refer to Podiatrist or multidisciplinary foot care

team

TAKE-HOME MESSAGE

“A foot ulcer is serious…”3 – help to prevent it!

REFERENCES1. UWA CSP. MMEx [Internet]. Perth, WA (Australia): MMEx;

2013 [updated 2013 Aug 21; cited 2013 Oct 20]. Available from: http://www.mmex.net.au

2. Australasian Podiatry Council. Diabetic Amputations in Australia. Brunswick East (VIC): Australasian Podiatry Council; 2013 Oct.

3. 85 per cent of diabetes amputations "entirely preventable”. Diabetes WA [Internet]. 2012 Aug 31 [cited 2013 Oct 20]; Diabetes WA News. Available from: http://www.diabeteswa.com.au/News_and_events/Diabetes_WA_News/News_Details/85_per_cent_of_diabetes_amputations

4. National Evidence-Based Guideline on Prevention, Identification and Management of Foot Complications: Part of the Guidelines on the management of Type 2 Diabetes [Internet]. Melbourne: National Health and Medical Research Council; 2011 [cited 2013 Oct 20]. Available from: http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/diabetes_foot_full_guideline_23062011.pdf