1. INNOVATION PANEL IMPLEMENTING “TOUCH THE TOES” Karen Davies DISN PRH

2. Aims of this presentation To communicate the need for this new initiative To explain how it fits with BSUH Trust and National Priorities To explain how it could be implemented To identify key support areas required from BSUH to facilitate implementation To use this forum as a means to obtain feedback from the panel and audience

3. Diabetes and Feet? Diabetic neuropathy is associated with an increased risk of ulceration A patient with diabetes has about a 25% lifetime risk for foot ulcer Early detection of loss of sensation allows HCP and patient to review management plan Screening for diabetic foot disease in community and inpatients settings predicts those at risk of ulceration (Rayman et al 2011)

4. What are the risk Factors for Diabetic Foot Problems Lack of sensation Absent Foot Pulses Foot Deformity Significant callus History of previous ulceration Unsuitable footwear Foot Pain Signs of ulceration

5. UKCYM01503b February 2013 Adapted from the Scottish Diabetes Group – Foot Action Group. Available at http://www.diabetesinscotland.org.uk/Publications/traffic%20light%20finalx3.pdf http://www.diabetesinscotland.org.uk/Publications/traffic%20light%20finalx3.pdf Diabetic foot risk stratification and triage

6. Setting the scene Approximately 6000 people with diabetes undergo leg, foot or toe amputations each year in England and many of these amputations are said to be avoidable. In 2010-11 the NHS in England spent an estimated 0.6% to 0.7% of it’s budget on diabetic foot ulceration and amputation, almost 650 million pounds (Kerr, 2012 ).

7. What is the situation at BSUH? NaDIA data provides baseline data Question 18 Foot examination recorded in the notes Limited screening March 2014- April 2015 SUI reported 51 new foot / heel sores within the trust The burden of diabetic foot disease is likely to increase The incidence of Type 2 diabetes is rising It is estimated that by 2025 five million people will have diabetes in the UK.

8. Preventing harm Impacts for the trust Reported as a serious incidents Increasing length of stay Increasing risk of infection Additional costs of treatment and surgery Personal impact on patient Immobility Inconvenience Pain Change in work / social life Time for appointments Ulceration and amputation substantially reduce quality of life, and are associated with high mortality. Studies suggest that only 50% of patients with diabetes who have had an amputation survive for a further two years.

9. What is the proposal? To encourage the Trust to “Think Feet” HOW To include foot check on admissions clerking assessment To include “Touch the toes” on the nursing staff assessment

10. What is touch the toes?

11. How could this be implemented? Nursing assessment Phased implementation Pilot initially at PRH 3- 4 wards 3 - 4 months ( Aug- Nov 15) Pilot will test data capture in addition to annual Nadia and SUI new foot sores, staff attitudes, knowledge pre and post implementation Pilot will test bite size education sessions delivered to engage staff Pilot will test documentation used Pilot will learn from feedback ward feedback

12. Removing barriers Equipment Skills and knowledge Engagement of staff and keeping agenda in focus – lets “think feet” Paperwork that works! Goals for Implementation and learning from this

13. Equipment required

14. Prevention

15. Support from the trust Support data analysis and recording Accurate coding HES New foot sores Analysis of information Supporting Communications “Think feet” banners on PC screens Inclusion in appropriate Trust paperwork Medical assessment paperwork Nursing assessment

16. Ingredients for success “You have to have a big vision and take very small steps to get there”. Jason Calaconis A need A vision / an outcome Energy Tenacity Debate and review SMART – goals

17. Any questions / feedback? Karen.davies@bsuk.nhs.uk Karen.davies@bsuk.nhs.uk