P91 Top to toe examination: An audit to assess the documentation of a foot exam for those admitted to hospital under medicine with diabetes

Published Date: 23rd March 2022

Publication Authors: Sullivan H, Westall S, Furlong NJ, McNulty S, Balafshan T, Narayanan RP, Bujawansa S, Hardy KJ, Pendlebury H

Background
10% of people with diabetes will suffer from a diabetes foot condition at some point. Those with diabetes related foot disease have high morbidity and mortality rate. They are at higher risk of pressure ulcers and other diabetes related complications such as heart disease or stroke. Patients with neuropathy and subsequent ulcers are not always aware of them. Therefore it is paramount and NICE recommended that anyone with diabetes has their foot examined upon admission to hospital.

Aim
To audit how many patients with diabetes admitted to Whiston hospital for a medical (non-foot related) reason have their feet examined.

Methods
A random selection of 50 patients between August 2020 and November 2020, notes were reviewed to identify: presenting complaint, location of clerking, grade of clinician and completion of foot inspection section of medical proforma.

Results
Of the 50, two did not have notes scanned, eight had documentation of a foot exam and 40 did not (83%), including six patients with an infection of unknown cause and five admitted for diabetes related reasons. Clerked by advanced nurse practitioners and junior doctors in accident and emergency and the acute medical unit.

Discussion
This is a concerning percentage of missing examination. In order to address this, the audit has been presented within the local department and at the trust audit meeting, to highlight to senior clinicians, as encouragement from all levels is required to change practice. Teaching has been provided and offered and a poster designed for medical clerking areas. Following this a re-audit will take place.

 

Sullivan, HR; Westall, S; Furlong, N; McNulty, S; Balafshan, T; Narayanan, P; Bujawansa, S; Hardy, K; Pendlebury, H. (2022). P91 Top to toe examination: An audit to assess the documentation of a foot exam for those admitted to hospital under medicine with diabetes. Diabetic Medicine. 39 (Suppl 1), P66-67

 

 

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