Implementing and sustaining evidence-based practices in long-term care.

Assessment and Management of Diabetic Foot Ulcers

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    It will provide direction to all nurses and the interprofessional team who provide care in all health-care settings to people (>15 years of age) with type 1 and/or type 2 diabetes and who have established diabetic foot ulcers. This best practice guideline provides evidence-based recommendations that will assist interdisciplinary teams with assessment and management of clients who are over the age of fifteen with established diabetic foot ulcers.

    Registered Nurses’ Association of Ontario (2013). RNAO Assessment and Management of Foot Ulcers for People with Diabetes. Toronto, ON: Author. This work is funded by the Ontario Ministry of Health and Long-Term Care. Retrieved from: http://rnao.ca/bpg/guidelines/assessment-and-management-foot-ulcers-people-diabetes-second-edition
     

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    This guideline focuses its recommendations on three areas: 1.Practice recommendations directed at the nurse 2.Education recommendations directed at the competencies required for practice 3.Organization and Policy recommendations addressing the importance of a supportive practice environment as an enabling factor for providing high quality nursing care, which includes ongoing evaluation of guideline implementation. Supplement: 2007

    This best practice guideline provides evidence-based recommendations for nurses who are not specialists in the area of Diabetes. These recommendations assist nurses to conduct risk assessments for foot ulcers, provide basic education for the prevention of foot ulcers and   implement the appropriate interventions when there is a high risk for ulcer or amputation present.
    Registered Nurses’ Association of Ontario (2007). RNAO Reducing foot Complications for People with Diabetes. Toronto, ON: Author. Retrieved from: http://rnao.ca/bpg/guidelines/reducing-foot-complications-people-diabetes

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    Foot Ulcer Gap Analysis

    Organizational assessment tool to assist with implementation and evaluation of the RNAO Assessment and Management of Foot Ulcers for People with Diabetes, 2nd Edition by comparing current practice to evidence-based practice. Source: Registered Nurses' Association of Ontario's Long-Term Care Best Practices Program, Toronto, ON. March 2013.

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    The Guide to Dressing Foot Wounds is found as Appendix R of the RNAO BPG, Assessment and Management of Foot Ulcers for People with Diabetes. Pg 147-149. The guide is adapted from the Canadian Association of Wound Care (CAWC) and was reprinted with permission in the BPG.

    Reference: Registered Nurses’ Association of Ontario. (2013). Appendix R of Assessment and Management of Foot Ulcers for People with Diabetes. Toronto, Canada: Author. pp. 147-149

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    Clinic Assessment tool is found as Appendix N of the RNAO BPG, Assessment and Management of Foot Ulcers for People with Diabetes. Pg 134-137.

    Reference: Registered Nurses’ Association of Ontario. (2013). Appendix N of Assessment and Management of Foot Ulcers for People with Diabetes. Toronto, Canada: Author. pp. 134-137.

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    Debridement Decision tool is found as Appendix P of the RNAO BPG, Assessment and Management of Foot Ulcers for People with Diabetes. Pg 143.

    Appendix P is based on the following resource : Rodd-Nielsen, E., Brown, J., Brooke, J., Fatum, H., Hill, M., Morin, J., St-Cyr, L., in Association with the Canadian Association for Enterostomal Therapy (CAET). Evidence-Based Recommendations for Conservative Sharp Debridement (2011).

    Reference: Registered Nurses’ Association of Ontario. (2013). Appendix P of Assessment and Management of Foot Ulcers for People with Diabetes. Toronto, Canada: Author. p. 143.

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    Description of Foot Deformities is found as Appendix H of the RNAO BPG, Assessment and Management of Foot Ulcers for People with Diabetes. Pg. 117-122.

    Registered Nurses’ Association of Ontario. (2013). Appendix H of Assessment and Management of Foot Ulcers for People with Diabetes. Toronto, Canada: Author. pp. 117-122 Illustrations provided by Nancy A. Bauer, BA, Bus Admin, RN, ET.

    Reference: Diabetes Nursing Interest Group & RNAO, (2004). Diabetes foot: Risk assessment education program. Images of the diabetic foot. Toronto: Registered Nurses’ Association of Ontario. Retrieved from: http://rnao.ca/bpg/guidelines/resources/diabetes-foot-risk-assessment-education-program

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    Diabetes Healthy Feet and You- Brochure is found as Appendix S of the RNAO BPG, Assessment and Management of Foot Ulcers for People with Diabetes. Pg 150-151. From “Diabetes, Healthy Feet and You,” by the Canadian Association of Wound Care, 2012, [Brochure].

    Copyright 2012 by Canadian Association of Wound Care. Reprinted with permission.

    Reference: Registered Nurses’ Association of Ontario. (2013). Appendix S of Assessment and Management of Foot Ulcers for People with Diabetes. Toronto, Canada: Author. pp. 150-151

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    Description of Foot Deformities is found as Appendix I of the RNAO BPG, Assessment and Management of Foot Ulcers for People with Diabetes. Pg. 123-126.

    Reference: Registered Nurses’ Association of Ontario. (2013). Appendix I of Assessment and Management of Foot Ulcers for People with Diabetes. Toronto, Canada: Author. pp. 123-126

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    Why should I be concerned about foot ulcers?

    Foot ulcers increase the risk of infection (a germ or bacteria that invades and damages the tissues) and may reduce your quality of life. While most foot ulcers heal, when they are left untreated, they could lead to foot amputations. This could lead to lost income, longer hospital stays and a need for special therapy.

    Retrieved from: http://rnao.ca/bpg/guidelines/fact-sheets/managing-foot-ulcers-people-diabetes