Reducing diabetes related amputations

The numbers are startling. Half of all limb amputations in Ontario are directly related to diabetes. Of those, 85 per cent are a result of a foot ulcer (breakdown of the skin) that won’t heal.

The impact is devastating, even deadly. Nearly 70 per cent of limb amputees with diabetes will not survive past five years. Cost to the provincial health care system, meanwhile, is more than $100 million a year for diabetes-related amputations. 

The Primary Care Diabetes Support Program (PCDSP) of St. Joseph’s Health Care London is working to reduce that toll. The team, in collaboration with the South West Regional Wound Care Program (SWRWCP), has developed a standardized screening, assessment and referral tool now being shared across the region. Called “St. Joseph’s FURST” (Foot Ulcer Risk Stratification Tool), the tool is fast, simple and reliable. It allows clinicians to quickly look for red flags before foot ulcers develop so that referrals can be made for preventative care, education can be provided to the patient, and close monitoring can be initiated.  

Patient being screed with diabetic foot ulcer tool

Betty Harvey, left, nurse practitioner and clinical nurse specialist with the Primary Care Diabetes Support Program, uses the St. Joseph’s FURST tool, which allows clinicians to quickly look for red flags before foot ulcers develop. The tool was developed as part of a region-wide effort to reduce diabetes-related amputations.  

The tool’s reliability is 92.7 per cent – significantly higher than the practice standard of 75 per cent for surveillance tools – and is a tremendous advance in the care of patients with diabetes in Southwestern Ontario, says Betty Harvey, nurse practitioner and clinical nurse specialist with the PCDSP.

“The end game is early identification and effective intervention of those at risk of diabetes-related foot ulcers,” says Harvey. “Once a person has a foot ulcer, it becomes a significant concern requiring much care and a great expense to the health care system. We know that close monitoring can reduce amputee rates by 40 to 85 per cent. Our goal was to design and implement a tool for the assessment and referral of individuals at low, medium and high risk for a diabetic foot ulcer that would be widely used and shape the care provided to these patients.”

With the tool, clinicians systematically check for any numbness in the feet in 10 spots, and for deformities such as calluses, bunions, hammer toes etc. to pick up any danger signs, explains Harvey. For example, in patients with diabetes, 60 per cent of calluses develop into ulcers.

In the South West LHIN the incidence of diabetes-related skin and soft tissue infection and amputations ranks above provincial rates and goals set by the Ontario Diabetes Strategy. With the tool, the hope is to create a coordinated approach that ensures individuals are receiving the best care by the most appropriate care provider in a timely way.

The tool, developed through the support of St. Joseph’s Health Care Foundation and the SWRWCP, is now being disseminated, along with e-learning in how to use it, to clinicians across the region through the SWRWCP.

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