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Calderdale and Huddersfield Diabetic Foot Pathway

    • This pathway is adapted from North West Coast Strategic Clinical Network: Diabetes Footcare Blueprint

    • Patient attends primary/community care appointment

    • ↓

      Complete initial foot assessment within 12 weeks

      Arrange up to 3 contact sessions with the practice nurse to include:
      footcare education within 1 week

    • ↓

      Referral received from GP

      OR

      Discharge Summary received from MDFT: Step down high or moderate risk, continued foot screening, continued management of stable foot ulcer

    • ↓

      Carry out a full foot assessment

      View larger image

    • ↓

      Legs and feet MUST be checked within 24 hours

      View larger image

    • ↓

      Monitor as part of pressure area care

    • ↓

      Assessment of patients feet (as per Trust decision aid)

      ↓

    • ↓

      Outpatient management of foot ulcer (must be seen by MDFT within 1 working day)

      ↓

      Assessment of patients feet (as per Trust decision aid)

      ↓

      Refer the person to the multidisciplinary foot care service within 24 hours of the initial examination of the person's feet. Transfer the responsibility of care to a consultant member of the multidisciplinary foot care service if a diabetic foot problem is the dominant clinical factor for inpatient care. [NICE NG19 1.1.3]

    • ↓

      Inpatient stay for management of foot ulcer (must be seen by MDFT within 72 hours before or after discharge)

      ↓

      Discharged back to GP and FPS with standard discharge summary plus additional form

    • ↓

      Initiate management / treatment, if any required

      Refer to MDFT with local/standard discharge summary plus additional information

    • ↓

      Discharge back to GP and FPS with MDFT discharge summary

    • ↓

      Complete RISK STRATIFICATION FORM,
      document risk and follow risk stratification pathway below

      ↓

    • Roles and Responsibilities

      General Practice

      • To assess new diabetic patients feet
      • Utilise risk stratification tool
      • READ code appropriate activity

      Foot Protection Service

      • Receive and act upon the GP referral within appropriate timescales
      • Provide discharge information as required - Inform GP practice

      MDFT

      • Receive and act upon the GP referral within appropriate timescales
      • Provide discharge information as required - Inform GP practice

      Patient

      • Inform the GP of any foot problems
      • Attend any appointments
      • Receive information leaflets

      Diabetic Peripheral Neuropathy and Claudication Pain Assessment and Treatment

      NICE Diabetic foot infection: antimicrobial prescribing

    • Roles and Responsibilities

      General Practice

      • Refer appropriate patients
      • To receive patient discharge summary and code on GP clinical system

      Foot Protection Service

      • Review patient within appropriate timescales
      • Receive and act upon discharge information or referral

      MDFT

      • Manage active foot ulceration
      • Discharge mod /high back to FPS
      • Provide discharge information to GP/FPS

      Patient

      • Ensure that appointments are kept
      • Contact GP or FPS if any new problems occur

      Diabetic Peripheral Neuropathy and Claudication Pain Assessment and Treatment

      NICE Diabetic foot infection: antimicrobial prescribing

    • Roles and Responsibilities

      General Practice

      • Receive patient discharge summary and code on GP clinical system

      Foot Protection Service

      • Review patient within appropriate timescales
      • Receive and act upon discharge information or referral

      MDFT

      • Identify a named consultant for patient care
      • Provide timely follow-up appointment
      • Completion of referral/ discharge forms
      • Refer to FPS for ongoing management/ continued screening on discharge

      Patient

      • Ensure that appointments are kept
      • Contact GP or FPS if any new problems occur

      Diabetic Peripheral Neuropathy and Claudication Pain Assessment and Treatment

      NICE Diabetic foot infection: antimicrobial prescribing

    • Foot screening and risk stratification tool ←Click to view summary table
      • No neuropathy AND
      • No limb ischaemia AND
      • No skin changes or foot deformity AND
      • No previous ulcer or amputation AND
      • Not on renal replacement therapy
      →
      • Annual Foot Review - Ensure this is arranged
      • Administer Footcare bundle
        • Document risk level for each foot individually
        • Inform patient of risk for each foot individually
        • Provide general foot care advice
        • Provide Foot Care Information Leaflets based on individual risk
        • Provide emergency contact numbers in case of development of acute foot problems
      • Provide Low Risk Feet leaflet
        • Other leaflets: Footwear advice | Holiday feet
      • Neuropathy OR
      • Non critical limb ischaemia OR
      • Foot deformity OR
      • Skin changes other than callus
      →
      • Refer to Community Podiatry/Foot Protection Service if not already known to them.
        • Guidance note: Ensure patient has appointment within 6-8 weeks. If already under Foot Protection Service then recall for assessment in 3-6 months
      • Administer Footcare bundle
        • Document risk level for each foot individually
        • Inform patient of risk for each foot individually
        • Provide general foot care advice
        • Provide Foot Care Information Leaflets based on individual risk
        • Provide emergency contact numbers in case of development of acute foot problems
      • Provide Moderate Risk Feet leaflet
        • Other leaflets: Footwear advice | Holiday feet

      If concerns of vascular compromise, in the absence of foot ulcer - follow vascular pathway (click here) [NEED LINK]

      • Neuropathy OR
      • Non critical limb ischaemia OR
      • Foot deformity OR
      • Skin changes other than callus
      →
      • Recall for assessment in 3-6 months
      • Administer Footcare bundle
        • Document risk level for each foot individually
        • Inform patient of risk for each foot individually
        • Provide general foot care advice
        • Provide Foot Care Information Leaflets based on individual risk
        • Provide emergency contact numbers in case of development of acute foot problems
      • Provide Moderate Risk Feet leaflet
        • Other leaflets: Footwear advice | Holiday feet

      If concerns of vascular compromise, in the absence of foot ulcer - follow vascular pathway (click here) [NEED LINK]

      • Neuropathy + non critical limb ischaemia OR
      • Neuropathy + callus/deformity OR
      • Non critical limb ischaemia + callus/deformity OR
      • Previous ulceration or amputation OR
      • On renal replacement therapy high risk of foot ulceration, amputation and/or premature death [Needs EDIT]
      →
      • Refer to Community Podiatry/Foot Protection Service if not already known to them.
        • Guidance note: Ensure patient has appointment within 2-4 weeks. If already under Foot Protection Service, then recall for assessment in 1-2 months (1-2 weeks if there is immediate concern)
      • Administer Footcare bundle
        • Document risk level for each foot individually
        • Inform patient of risk for each foot individually
        • Provide general foot care advice
        • Provide Foot Care Information Leaflets based on individual risk
        • Provide emergency contact numbers in case of development of acute foot problems
      • Provide High Risk Feet leaflet
        • Other leaflets: Footwear advice | Holiday feet

      If concerns of vascular compromise, in the absence of foot ulcer - follow vascular pathway (click here) [NEED LINK]

      • Neuropathy + non critical limb ischaemia OR
      • Neuropathy + callus/deformity OR
      • Non critical limb ischaemia + callus/deformity OR
      • Previous ulceration or amputation OR
      • On renal replacement therapy high risk of foot ulceration, amputation and/or premature death [Needs EDIT]
      →
      • Recall for assessment in 1-2 months the frequency might be increased to 1-2 weeks if there is immediate concern for those at higher risk
      • Administer Footcare bundle
        • Document risk level for each foot individually
        • Inform patient of risk for each foot individually
        • Provide general foot care advice
        • Provide Foot Care Information Leaflets based on individual risk
        • Provide emergency contact numbers in case of development of acute foot problems
      • Provide High Risk Feet leaflet
        • Other leaflets: Footwear advice | Holiday feet

      If concerns of vascular compromise, in the absence of foot ulcer - follow vascular pathway (click here) [NEED LINK]

      • Ulceration
      • Suspected Charcot neuroarthropathy
      • Cellulitis or spreading infection
      →
      • Same day referral to Hospital Multidisciplinary Foot/Diabetic Foot Clinic.
        • Patient to be seen by MDFT within 1 working day.
      • Provide Diabetic Foot Ulcer | Charcot Foot leaflet
      • Ulceration
      • Suspected Charcot neuroarthropathy
      • Cellulitis or spreading infection
      →
      • Same day referral to Hospital Multidisciplinary Foot/Diabetic Foot Clinic.
        • Patient to be seen by MDFT within 1 working day.
      • Or, if stable ulcer, continue ongoing monitoring
      • Provide Diabetic Foot Ulcer | Charcot Foot leaflet
      • Active foot disease AND systemically ill
      • Ulceration with limb ischaemia
      • Critical limb ischaemia or gangrene
      • Deep seated infection including abscess or osteomyelitis
      →
      • Send directly to emergency services via A/E
      • Provide Diabetic Foot Ulcer leaflet