A St. Joseph’s “FURST” has the potential to significantly reduce diabetes-related amputations across the region

Nov. 05, 2018

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London, Ontario  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.

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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For more information:

Dahlia Reich, Communication Consultant St. Joseph’s Health Care London
(519) 646-6100 ext. 65294, pager 10117

About the Primary Care Diabetes Support Program

The Primary Care Diabetes Support Program, located at St. Joseph’s Family Medical and Dental Centre in London, provides diabetes education and support for those without a family doctor or who live with various challenges that make managing diabetes more difficult, such as economic hardship, language barriers, and any issues or illnesses that can make navigating the health care system challenging. A multidisciplinary team teaches patients how to become diabetes self-managers and helps them access the resources they need to manage their diabetes effectively. The team also assists family physicians in London to build capacity for diabetes care in their own practices. The Primary Care Diabetes Support Program is part of St. Joseph’s Centre for Diabetes, Endocrinology and Metabolism.

About St. Joseph’s Health Care London

Renowned for compassionate care, St. Joseph’s Health Care London is a leading academic health care centre in Canada dedicated to helping people live to their fullest by minimizing the effects of injury, disease and disability through excellence in care, teaching and research. Through partnership with Lawson Health Research Institute and our collaborative engagement with other health care and academic partners, St. Joseph’s has become an international leader in the areas of: chronic disease management; medical imaging; specialized mental health care; rehabilitation and specialized geriatrics; and surgery. St. Joseph’s operates through a wide range of hospital, clinic and long-term and community-based settings, including: St. Joseph’s Hospital; Parkwood Institute; Mount Hope Centre for Long Term Care; and the Southwest Centre for Forensic Mental Health Care. For more information, visit www.sjhc.london.on.ca.

About the South West Regional Wound Care Program

The South West Regional Wound Care Program (SWRWCP) advocates for the integrated delivery of evidence-informed skin and wound care that spans the continuum of care. In collaboration with our healthcare sector partners (hospitals, long-term care, community service provider agencies, and primary care facilities), the SWRWCP delivers a coordinated strategy of skin and wound care informed by best practice. The approaches utilized by the SWRWCP to sustain best practices include: the development and implementation of an educational framework that promotes best practice for wound prevention and management; encourages the exploration of new technologies for wound management; supports quality research; promotes an interdisciplinary team approach; assists in cross-sectoral relationship development, communication, and transitions in care; and implements a system of performance monitoring and quality reporting.

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