Posts

NOW UPDATED: Ontario Health’s Diabetic Foot Ulcers: Care for Adults in All Settings quality standard (originally released in 2017) addresses care for adults 18 years of age and older who have developed or are at risk of developing a diabetic foot ulcer. The quality standard focuses on best practices for prevention, assessment, diagnosis, and treatment, including frequent assessment of risk factors for diabetic foot ulcers, patient education on diabetes and foot care, timely referral to interprofessional care, comprehensive assessment, appropriate treatment, and individualized care planning that includes care transition considerations.

This update aligns the quality standard with the most recent clinical evidence and best practice guidance. For a summary of updates, please refer to page 6 of the Diabetic Foot Ulcers quality standard.

The quality standard includes 12 quality statements that target care considerations that have high potential for improving the quality of care in Ontario for adults with or at risk of developing diabetic foot ulcers. To complement this guidance, please refer to the list of tools and resources, below, to assist in implementing care recommendations within your practice.

Are there other tools or resources you use? Do you have experience implementing these tools? If you have feedback about any of these tools, please use the comments section below to share!

Tools and Resources for People With Diabetic Foot Ulcers, Their Families, and Their Care Partners

• Healthy Feet—Wounds Canada’s resources, tools and information on foot health for people with diabetes
• Preventing and Managing Diabetic Foot Ulcers—Wounds Canada’s guidance on maintaining foot health for people with diabetic foot ulcers
• Foot Care: A Step Toward Good Health—Diabetes Canada’s information about diabetes’ effects on feet and what can be done to keep feet healthy
• Diabetes and Foot Care: A Checklist—Diabetes Canada’s dos and don’ts when caring for one’s feet
• My Diabetic Foot Ulcer Self-Care Wound Dressing Guide—South West Regional Wound Care Program’s step-by-step guide for patients and care partners when changing diabetic foot ulcer dressings

Tools and Resources for Clinicians

General Training and Education

• Management of Diabetic Foot Ulcers—Project ECHO’s guidance for clinicians when caring for people with diabetic foot ulcers
• Prevention and Management of Diabetic Foot Ulcers—Wounds Canada’s clinician-focused Foundations of Best Practice for Skin and Wound Management article
• Ontario Wound Care Interest Group—Registered Nurses’ Association of Ontario’s group dedicated to establishing wound care networks, promoting evidence-based practices, supporting access resources needed to provide timely care, and facilitating access to clinical training
• e-footcare—A free online course, designed with international experts for clinicians who care for people with diabetes, with the aim of improving clinician knowledge about diabetic foot complications that can lead to amputations
• Diabetic Foot Ulcer Management in Resource-Limited Settings—Robustly developed (through the Delphi consensus process) best practices for wound bed preparation in rural and under resourced settings

Risk Assessment:

• Ankle–Brachial Pressure Index (ABPI) and Toe–Brachial Pressure Index (TBPI) Education Module—Southern Health’s guide for measuring and interpreting ankle–brachial pressure index and toe–brachial pressure index values in adults when using handheld Doppler and photoplethysmography
• Diabetic Foot Ulcer Risk Stratification and Referral Algorithm—St. Joseph’s Health Care London and the South West Regional Wound Care Program’s tool for risk assessment and follow-up plan development
• Inlow 60-second Diabetic Foot Screen—Wounds Canada’s 2022 update for risk screening and care planning for diabetic foot ulcers
• Simplified 60 Second Screen for the High Risk Diabetic Foot—Woundpedia’s simplified diabetic foot screen

Interprofessional Care Pathway and Referral

• Diabetes Foot Care Clinical Pathway—Alberta Health Services’ guide for health care providers to enhance early detection and timely treatment of diabetes-related foot problems
• Fast-Track Pathway for Diabetic Foot Ulceration—D-Foot International’s fast-track care pathway
• Interprofessional Approach to Wound Care—Wounds Canada’s recommendations and resources to facilitate an interprofessional team approach to wound care
• Criteria for Interdisciplinary Referrals—South West Regional Wound Care Program’s criteria for referral to interdisciplinary team for wound care

Pressure Redistribution:

• Guideline: Fiberglass Total Contact Casting, Removable Cast Walkers, and Irremovable CastWalkers to Treat Diabetic Neuropathic Foot Ulcers—South West Regional Wound Care Program’s guidance on the types and use of devices to treat diabetic foot ulcers
• Provider Pathway for Offloading Devices for Individuals with Diabetic Foot Ulcers— South West Regional Wound Care Program’s offloading device care pathway to manage patients with diabetic foot ulcers
• Offloading Plantar Pressure in Diabetes—Wounds Canada’s guide to selecting an appropriate offloading device for patients with plantar diabetic foot ulcers

Other Resources

Ontario Health has developed other quality standards and patient guides on diabetes and other chronic conditions that may be useful, including:

Diabetes:

• Diabetes in Pregnancy
• Prediabetes and Type 2 Diabetes
• Type1 Diabetes

Diabetic Wound Care:

• Pressure Injuries
• Venous Leg Ulcers
• Surgical Site Infections
• Medication Safety

Pain:

• Opioid Prescribing for Acute Pain
• Opioid Prescribing for Chronic Pain
• Chronic Pain
• Transitions Between Hospital and Home