IMPACT OF EDUCATION ON THE REDUCTION OF AMPUTATION RATES AMONG DIABETICS Tarra Robinson, ABSN Student Samuel Merritt U

1. IMPACT OF EDUCATION ON THE REDUCTION OF AMPUTATION RATES AMONG DIABETICS Tarra Robinson, ABSN Student Samuel Merritt University, San Francisco, CA Clinical Question Does patient and health care provider education on proper foot care reduce the rate of amputation among diabetics? • Synthesis of findings • Several studies have shown that amputation rates can be reduced by up to 50% in diabetic patients if health care providers perform foot and foot wear inspections at all regular visits and patients are educated on the importance of foot and shoe care (Apelqvist & Larsson, 2000). • Results from developed countries varied greatly from underdeveloped countries who have attempted to implement foot care education programs due to lack of resources and poor record keeping (Al-Wahbi, 2010). • More than 85% of foot ulcers are preventable with the implementation of multidisciplinary diabetic foot care which results in early intervention, better wound management and decreased rate of re-ulceration which leads to decrease in amputations (Rogers & Bevilacqua, 2010). • *In all of studies the common thread is the need for patient education and a multidisciplinary approach to prevention of diabetic foot complications in the effort to reduce amputation rates. Recommendation about practice Based on the evidence it is my recommendation that the health care system create and implement multidisciplinary diabetic foot care education programs within health care communities. The goal is to educate patients and health care providers on preventative measures to decrease amputation rates in diabetics. • Conclusion • The studies all represented evidence that there is a need for extensive patient and health care provider education in diabetic foot care. • Reduction in amputation rates could substantially lower the amount of health care cost associated with surgery and rehabilitation for the diabetic patient population. • The most beneficial impact of an educational program would be the maintaining or improving in quality of life for diabetic patients if foot complications or amputations can be prevented . Review of the literature A positive correlation is demonstrated between improvement in education among patients and health care providers on proper diabetic foot care with a decrease in amputation rates. The literature is a combination of original and peer reviewed research. The samples are comprised of diabetics who have encountered foot complications such as neuropathy or ulceration. The research was conducted in hospitals and outpatient facilities. • Implementation • There is strong evidence that patient and health care provider education can substantially reduce amputation rates among diabetic patients. • All diabetic patients need their feet thoroughly examined at all scheduled and unscheduled visits to facilitate early intervention. • A Referral to a foot care specialist and/or diabetic educator must be made for any suspected abnormalities and at minimum semi-annually as a preventative measure. References Al-Wahbi, A. M. (2010). Impact of a diabetic foot care education program on lower limb amputation rate. Vascular Health and Risk Management, 6, 923-934. doi:10.2147/VHRM.S13569 Apelqvist, J., & Larsson, J. (2000). What is the most effective way to reduce incidence of amputation in the diabetic foot? Diabetes/metabolism Research and Reviews, 16 Suppl 1, S75-83. Rogers, L. C., & Bevilacqua, N. J. (2010). Organized programs to prevent lower-extremity amputations. Journal of the American Podiatric Medical Association, 100(2), 101-104. • Limitations • Due the small sample size in all of the reviewed studies. It is possible that there is under-representation of the true statistical significance of an educational program impact. In the future larger studies will need to be conducted to give a better representation of the impact on this large and diverse population. • The sample population demographics such as ethnicity, social, religious, economic, or educational background were not mentioned. These are all factors that could possibly affect patient compliance and or access to health care programs. Method The implementation of diabetic foot care teams comprised of multidisciplinary specialists such as vascular surgeons, diabetiologists, infectious disease specialists, diabetic educators, surgical/medical nurses. The goal of the study is to determine the impact of educational programs on prevention and outcomes of diabetic foot complications (Al-Wahbi, 2010).