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Operational Delivery of the Multi-Disciplinary Care Pathway for Diabetic Foot Problems

This document aims to provide a framework for the operational delivery of hospital trust based diabetic foot services, ensuring that patients with acute diabetic foot disease receive the same high quality of care irrespective of where they present.

These are joint recommendations from: British Orthopaedic Association, British Orthopaedic Foot and Ankle Society, Vascular Society, Diabetes UK, Association of British Clinical Diabetologists, Foot in Diabetes UK; British Association of Prosthetists and Orthotists.

Service provision should be geared towards meeting patient priorities at each step in the pathway. These priorities are:

1. To get better, as quickly as possible, whilst reducing risk of further morbidity.

2. To avoid hospital admission if possible, and certainly admission to a hospital that is distant from home.

3. To avoid major and minor amputation.

4. To be managed speedily, effectively and efficiently with management plans focused on the patient’s individual circumstances and their personal needs.

5. To have their diabetes and other medical conditions well managed at the same time that their foot disease is being assessed and treated.

The recommendations cover:

  • commissioning
  • service design
  • foot screening
  • foot protection
  • multi-disciplinary foot care service
  • outpatient Management of Acute Diabetic Foot Complications
  • management of Diabetic Foot Emergencies- Discharge Planning
  • management of the patient undergoing major amputation
  • monitoring implementation and the National Diabetes Footcare Audit (NDFA)
  • training.
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