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

Assessment and Management of Diabetic Foot Ulcers

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  • RNAO BPG - Assessment and Management of Foot Ulcers For People With Diabetes, Second Edition
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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
     

  • RNAO BPG - Reducing Foot Complications for People with Diabetes
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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

  • RNAO BPG Gap Analysis -Assessment and Management of Foot Ulcers for People with Diabetes
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    A tool to assist with comparing your organization’s current practice with evidence-based RNAO best practice recommendations.

    Registered Nurses Association of Ontario (2022) Gap Analysis- Assessment and Management of Foot Ulcers for People with Diabetes. Toronto, ON.

  • RNAO BPG Gap Analysis- Reducing Foot Complications for People with Diabetes
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    A tool to assist with comparing your organization’s current practice with evidence-based RNAO best practice recommendations.

    Registered Nurses Association of Ontario (2022) Gap Analysis-Reducing Foot Complications for People with Diabetes. Toronto, ON.

  • A Guide to Dressing Foot Wounds – RNAO Appendix R (Foot Ulcer)
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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

  • Clinic Assessment Tool – RNAO Appendix N (Foot Ulcer)
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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.

  • Debridement Decision-Making Algorithm – RNAO Appendix P (Foot Ulcer)
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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.

  • Description of Foot Deformities – RNAO Appendix H (Foot Ulcer)
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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

  • Diabetes, Healthy Feet and You – Brochure – RNAO Appendix S (Foot Ulcer)
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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

  • Diagnostic Tests to Determine Vascular Supply – RNAO Appendix I (Foot Ulcer)
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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

  • Managing Foot Ulcers in People with Diabetes – RNAO Fact Sheet
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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

  • Offloading Devices – RNAO Appendix M (Foot Ulcer)
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    Offloading Devices is found as Appendix M of the RNAO BPG, Assessment and Management of Foot Ulcers for People with Diabetes. Pgs. 130-133.

    Reference: Registered Nurses’ Association of Ontario. (2013). Appendix M of Assessment and Management of Foot Ulcers for People with Diabetes. Toronto, Canada: Author. pp.130-133.

  • Optional Treatment Modalities – RNAO Appendix O (Foot Ucer)
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    Optional Treatment Modalities is found as Appendix O of the RNAO BPG, Assessment and Management of Foot Ulcers for People with Diabetes. Pg 138-142.

    Reference: Registered Nurses’ Association of Ontario. (2013). Appendix O of Assessment and Management of Foot Ulcers for People with Diabetes. Toronto, Canada: Author. pp. 138-142.

  • PEDIS: Diabetic Foot Ulcer Classification System – RNAO Appendix G (Foot Ulcer)
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    PEDIS: Diabetic Foot Ulcer Classification System is found as Appendix G of the RNAO BPG, Assessment and Management of Foot Ulcers for People with Diabetes. Pg. 113-116. Reference: Registered Nurses’ Association of Ontario. (2013). Appendix G of Assessment and Management of Foot Ulcers for People with Diabetes. Toronto, Canada: Author. pp. 113-116

  • Pressure Ulcer Scale for Healing (PUSH) Tool 3.0 – RNAO Appendix T (Foot Ulcer)
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    The Pressure Ulcer Scale for Healing is found as Appendix T of the RNAO BPG, Assessment and Management of Foot Ulcers for People with Diabetes. Pg 152-153. From “Pressure Ulcer Scale for Healing tool (PUSH tool) 3.0,” by National Pressure Ulcer Advisory Panel, 2012. Retrieved from http://www.npuap.org/ wp-content/uploads/2012/02/push3.pdf Reprinted with permission

    Reference: Registered Nurses’ Association of Ontario. (2013). Appendix T of Assessment and Management of Foot Ulcers for People with Diabetes. Toronto, Canada: Author. pp. 152-153

  • Reducing Foot Complications for People with Diabetes – RNAO BPG Supplement
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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

  • Reducing Foot Complications for People with Diabetes – RNAO Summary of Recommendations
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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

  • Suggestions for Assessing and Selecting Shoes and Socks – RNAO Appendix L (Foot Ulcer)
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    Suggestions for Assessing and Selecting Shoes and Socks is found as Appendix L of the RNAO BPG, Assessment and Management of Foot Ulcers for People with Diabetes. Pg 129.

    Adapted from: International Diabetes Federation (2005). Diabetes and Foot Care – A Time to Act. Retrieved from http://www.idf.org/webdata/docs/T2A_Introduction.pdf International Diabetes Group & International Working Group on the Diabetic Foot. In Lorimer, D. L., French, G. J., O’Donnell, M., Burrow, J. G., & Wall, B. (2006). Neale’s Disorder of the Foot. Edinburgh: Churchill Livingstone Elsevier. Zangaro, G. A. & Hull, M. M. (1999). Diabetic neuropathy: Pathophysiology and prevention of foot ulcers. Clinical Nurse Specialist, 13(2), 57-65. C)

    Reference: Registered Nurses’ Association of Ontario. (2013). Appendix L of Assessment and Management of Foot Ulcers for People with Diabetes. Toronto, Canada: Author. p. 129.

  • Taking Care of Your Legs – RNAO Fact Sheet
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    Venous leg ulcers can occur in both men and women; and may develop as a result of any injury to the leg or conditions such as varicose vein, blood clot in the leg, multiple pregnancies, overweight and standing for long periods of time (e.g., job related situations). They can take long time to heal and are costly to treat. Venous leg ulcers can also cause you to not be able to move and get around.

    Retrieved from: http://rnao.ca/bpg/fact-sheets/taking-care-your-legs

  • Topical Antimicrobial Agents – RNAO Appendix Q (Foot Ulcer)
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    Topical Antimicrobial Agents is found as Appendix Q of the RNAO BPG, Assessment and Management of Foot Ulcers for People with Diabetes. Pg 144-146.

    Reprinted in the BPG with permission from Dr. R. G. Sibbald©2013

    Reference: Registered Nurses’ Association of Ontario. (2013). Appendix Q of Assessment and Management of Foot Ulcers for People with Diabetes. Toronto, Canada: Author. pp. 144-146.

  • University of Texas Foot Classification System – Categories 0-3: Risk Factors for Ulceration –
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    University Foot Classification system-Categories 0-3 risk Factors for Amputation is found as Appendix E of the RNAO BPG, Assessment and Management of Foot Ulcers for People with Diabetes. Pgs. 110-111.

    Note. From “Practical criteria for screening patients at high risk for diabetic foot ulceration,” by L.A. Lavery, D.G. Armstrong, S.A. Vela, T.L. Quebedeau and J.G. Fleishchli, 1998, Archives of Internal Medicine,158(2), p. 157-162. Reprinted with permission of Dr. D.G. Armstrong.

    Reference: Registered Nurses’ Association of Ontario. (2013). Appendix E of Assessment and Management of Foot Ulcers for People with Diabetes. Toronto, Canada: Author. pp. 110-111

  • University of Texas Foot Classification System – Categories 4-6: Risk Factors for Amputation –
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    University Foot Classification system-Categories 4-6 risk Factors for Amputation is found as Appendix D of the RNAO BPG, Assessment and Management of Foot Ulcers for People with Diabetes. Pg 109.

    Note. From “Practical criteria for screening patients at high risk for diabetic foot ulceration,” by L.A. Lavery, D.G. Armstrong, S.A. Vela, T.L. Quebedeau and J.G. Fleishchli, 1998, Archives of Internal Medicine,158(2), p. 157-162. Reprinted with permission of Dr. D.G. Armstrong

    Reference: Registered Nurses’ Association of Ontario. (2013). Appendix D of Assessment and Management of Foot Ulcers for People with Diabetes. Toronto, Canada: Author. pg. 109.

  • University of Texas Health Science Center San Antonio Diabetic Wound Classification System –
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    University of Texas Health Science Center Classification System is found as Appendix F of the RNAO BPG, Assessment and Management of Foot Ulcers for People with Diabetes. Pg 112.

    Note. From “Validation of a diabetic wound classification system: The contribution of depth, infection and ischemia to risk of amputation,” by D.G. Armstrong, L.A. Lavery and L.B. Harkless, 1998, Diabetes Care, 21(5), p. 855-859. Reprinted with permission

    Reference: Registered Nurses’ Association of Ontario. (2013). Appendix F of Assessment and Management of Foot Ulcers for People with Diabetes. Toronto, Canada: Author. p 112.

  • Use of the Semmes-Weinstein Monofilament – RNAO Appendix K (Foot Ulcer)
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    Use of the Semmes-Weinstein monofilament is found as Appendix K of the RNAO BPG, Assessment and Management of Foot Ulcers for People with Diabetes. Pg 128.

    Reference: Registered Nurses’ Association of Ontario. (2013). Appendix K of Assessment and Management of Foot Ulcers for People with Diabetes. Toronto, Canada: Author. p. 128.

  • Wound Management education
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    This free e-learn modules which cover everything from the skin structure and blood composition right up to pressure ulcers and a guide to prevention. Each training module has interactive diagrams and has a certificate when the module is completed. To test comprehensive learning the user can read a case study and try and heal a wound.
    Website: http://www.globalwoundacademy.com/

    https://www.smith-nephew.com/en/health-care-professionals/medical-education

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  • Wound Swabbing Technique – RNAO Appendix J (Foot Ulcer)
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    Wound swabbing Techniques is found as Appendix J of the RNAO BPG, Assessment and Management of Foot Ulcers for People with Diabetes. Pg 127.

    Note following Appendix in BPG identifies that this resource was reprinted with permission from C. Harris at Care Partners.

    Reference: Registered Nurses’ Association of Ontario. (2013). Appendix J of Assessment and Management of Foot Ulcers for People with Diabetes. Toronto, Canada: Author. p. 127.