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

Assessment and Management of Diabetic Foot Ulcers

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  • RNAO BPG - Diabetic foot ulcers: Prevention, assessment and management, Third edition
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    This BPG replaces two RNAO BPGs: Reducing Foot Complications for People with Diabetes (7) published in 2007 and Assessment and Management of Foot Ulcers for People with Diabetes (8) published in 2013. These BPGs were merged because of the overlapping clinical concepts in each BPG.

    The purpose of this third edition guideline is to provide nurses and members of the interprofessional team, persons at risk of or living with a Diabetic Foot Ulcers (DFU) and their care partners with evidence-based recommendations on the prevention, assessment and management of DFUs.

    Registered Nurses’ Association of Ontario (2024). RNAO Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, ON: Author. Retrieved from: http://https://rnao.ca/bpg/guidelines/diabetic-foot-ulcer

    This work is funded by the Ontario Ministry of Health and Long-Term Care.

  • RNAO BPG Gap Analysis- Diabetic foot ulcers: assessment, prevention and management, third
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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 (2024). RNAO Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, ON: Author

  • Description of the Leading Change Toolkit: Appendix M
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    The Leading Change Toolkit includes two frameworks- the Social Movement Action (SMA) Framework and the Knowledge-to-Action (KTA) Framework. Both frameworks outline the concept of implementation and its interrelated components. The toolkit is based on available evidence, theoretical perspectives and consensus. We recommend the Leading Change Toolkit for guiding the implementation of any BPG in health care or social service organizations, including academic centres

    Reference: Registered Nurses’ Association of Ontario, (2024). Appendix M of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author. pp. 126-127.
     

  • DFU-VIPS: Appendix J
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    "DFU-VIPS" (diabetic foot ulcer- vascular supply, infection, pressure and sharp debridement and social determinants of health), is an acronym that assists as a memory aid for items to assess when providing care to a person at risk of or living with a diabetic foot ulcer. 

    Reference: Registered Nurses’ Association of Ontario, (2024). Appendix J of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author. pp. 117.

  • Diabetes foot risk assessment triage referral example: Appendix G
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    This risk assessment triage referral form is an example form for primary health providers to utilize when requesting referrals to a specialized wound care team.

    Reference: Registered Nurses’ Association of Ontario, (2024). Appendix G of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author. pp. 113.

  • Education statements: Appendix L
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    RNAO clinical BPGs included education recommendations directed to those responsible for the academic and in-service education of nursing students, nurses and the interprofessional team. These recommendations outlined core content and training strategies required for entry-level health programs, continued education and professional development.

    Reference: Registered Nurses’ Association of Ontario, (2024). Appendix L of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author. pp. 121-125.
     

     

  • Examples of validated diabetic foot assessment tools: Appendix H
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    These validated assessment tools will assist health providers in conducting a comprehensive assessment of a diabetic foot ulcer and provide a baseline for the diabetic foot ulcer. Examples of diabetic foot classification tools and wound progression tools are provided.

    Reference: Registered Nurses’ Association of Ontario, (2024). Appendix H of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author. pp. 114.

  • Glossary of Terms: Appendix A
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    This resource is a glossary of terms used throughout the best practice guideline: Diabetic foot ulcers: Prevention, assessment and management. 

    Reference: Registered Nurses’ Association of Ontario, (2024). Appendix A of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author. pp. 86-95.

     

     

  • Images and comparisons of different chronic wounds: Appendix I
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    This table compares different types of chronic wounds to assist health providers in differentiating wounds they may see in clinical practice.

    Reference: Registered Nurses’ Association of Ontario, (2024). Appendix I of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author. pp. 115-116 .

  • Inlow's 60 second diabetic foot screen: Appendix D
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    This screening guide provides a systematic method that can be used by health providers for foot ulcer prevention and ongoing screening after an ulcer or complication occurs. 

    Reference: Registered Nurses’ Association of Ontario, (2024). Appendix D of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author pp. 104-105.

  • IWGDF risk stratification system: Appendix E
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    The IWGDF risk stratification system allows health providers to establish foot screening and examination frequency based on resulting risk categories.

    Reference: Registered Nurses’ Association of Ontario, (2024). Appendix E of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author. pp. 106.

     

  • 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: Appendix K
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    This fact sheet outlines factors to consider regarding offloading pressures, recommendations for offloading devices for forefoot ulcers and offloading device choices (with advantages and disadvantages).

    Reference: Registered Nurses’ Association of Ontario, (2024). Appendix K of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author. pp. 118-120.
     

  • RNAO guidelines and resources that align with this guideline: Appendix B
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    Appendix B is a list of topics and resources that align with the best practice guideline: Diabetic foot ulcers: Prevention, assessment and management.

    Reference: Registered Nurses’ Association of Ontario, (2024). Appendix b of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author pp. 96.

     

     

  • Self-screening tool example: Appendix F
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    This self-screening tool provides a systematic method for foot ulcer prevention and ongoing screening, which can be used by individuals and care partners.

    Reference: Registered Nurses’ Association of Ontario, (2024). Appendix F of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author. pp. 107-112.

  • Strategies to provide culturally safe care: Appendix C
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    This resource features the Arksey and O’Malley framework (186), a scoping review conducted to explore the current evidence on culturally safe strategies that can be used in the care of persons with diabetes or, at risk of or living with diabetic foot ulcers and their care partners.

    Reference: Registered Nurses’ Association of Ontario, (2024). Appendix C of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author pp. 97-103.

     

  • 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

  • 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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