Page 180 - HA Convention 2015

Service Priorities and Programmes Free Papers

SPP6.3 Managing Service Demands 10:45 Room 221

Service Enhancement for Diabetic Foot Patients with a Structured Screening and Educational Programme
Kwong WF, Chan PL, Wong CM, Ng J
Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong

Introduction

In Hong Kong, the prevalence of diabetic mellitus (DM) is increasing and affecting 5 to 10% of the population. Foot ulcer
is one of the complications of DM. Once patients develop an ulcer, they always readmit with longer hospitalisation for
interventions, and there is a 10 to 30% chance of progressing to amputation (Daniel et al, 2010). Therefore, it is crucial
for people to be screened not only for wound or ulcers but also the risk factors. Through a structured foot screening and
education programme, patient at risk can be identified early, so that corresponding interventions and referrals can be
provided accordingly.

Objectives

(1) To early identify risk factors for known/newly diagnosed diabetic patients through a structured foot screening programme;
(2) to enhance patient service and safety with timely referrals to other specialties and/or allied health accordingly; (3) to raise
patients’ awareness on DM foot care; and (4) to provide continuous DM foot care in nurse clinic.

Tuesday, 19 May Methodology

A structured foot screening and educational programme was conducted from September 2013 to January 2015 in Queen
Mary Hospital. All emergency admitted patients were screened for history of known/newly diagnosed DM. An Inlow
60-second diabetic foot screening tool was used by nurses under consent with logistic flow. Recommended subsequent
screening intervals were categorised in four from one month to yearly. Different parameters of deficit were also identified.
Patients were categorised into one of the five categories for suggested referrals such as podiatrist, P&O, vascular, endocrine
and/or orthopaedics and traumatology (O&T) foot teams. With physician-nurse collaboration, timely and appropriate referrals
are recommended without delay. Foot care education and patient satisfaction survey were conducted accordingly. Data and
related variables were collected and analysed statistically.

Results

350 known/newly diagnosed DM patients were recruited to the programme from September 2013 to January 2015. There
were 27.4% (96) and 72.6% (254) with and without foot ulcer respectively. In foot ulcer group, the mean time for suggested
referred consultations from time of admission were 1.5 days (podiatrist); 2.2 days (vascular) and 2.5 days (endocrine), an
overall mean of 2.2 days. It was decreased by 42% when compared with 3.8 days before the programme. The average length
of stay was also decreased by 30.4% to 7.1 days as compared with 10.2 days before. In the non-ulcer group, there were 75%,
68% and 60% requiring at least one, two and three referrals respectively. The success of early detection for newly diagnosed
DM was 21 (6%) patients with appropriate referrals. The average length of stay was decreased by 52.4% to 3.2 days when
compared with 6.73 days before the intervention. There were 80% of patients were satisfied with, in particular for, the time
spent in performing foot screening and the continuity care for providing follow-up service in O&T nurse clinic.

HOSPITAL AUTHORITY CONVENTION 2015

178