The DIAFOOT Project: developing and implementing an evidence based acute diabetic foot care bundle Dr Nida Chammas Clinical Lead DIAFOOT project NIHR CLAHRC NW London February 2014
Background • 15% of diabetic patients will develop a diabetic foot ulcer • Lifetime risk is 25%
20% of diabetic admissions to hospital due to foot problems • Total expenditure on inpatient care for foot ulceration and amputation in 2010–11 is at £257 million. 11
Diabetic foot ulcers precede >80% of amputations in Diabetic patients (100 people per week)
Mortality DFU patients have 2.4 times the mortality rate of non-ulcerated diabetic patients.
Financial Impact £700 million per year in England
Nida Chammas Khalid Ahmed Professor Edmonds DIAFOOT Project £104,000 Essam Ramhamadany CLAHRC Sandra Wilson NICE
AIM To implement the current national guidelines for inpatient management of acute diabetic foot problems • NICE guidelines 2011 • Diabetes UK ( Putting Feet First)2009
Junior Drs Dan Brown Patients Nida Chammas Diabetic Foot care bundle CLAHRC Team Elaine Hui Sandra Wilson Khalid Ahmed Essam Ramhamadany
Results • Implementation for 60 consecutive weeks (December 2011 to January 2013) • 991 patients screened • 254 (25.6%) identified as potential DF disease. • 99 (38.9%) patients assessed by a doctor. • 50% of patients had signs of ulceration; 43% had at least two or more signs of DF
Summary Approximately one thousand patients were screened and nearly 1 in 10 patients identified as positive for acute DF disease were assessed by a doctor. This demonstrates that a significant proportion of admissions were influenced by this quality improvement project.
Conclusion The DIAFOOT project represents a service improvement model, promoting new strategies for implementation of evidence-based practice.