In the third of our guest posts to mark #WorldDiabetesDay 2020, Fatima Cassim from our Faculty of Podiatric Medicine writes about the importance of teams in providing excellent patient care, especially throughout the current pandemic.
As we raise awareness of this challenging illness, we’re proud of the contribution all our AHPs make to patient care thoughout the world each and every day.
In the UK it is estimated that the cost of management of diabetes foot ulcers and its complications is approximately £1 billion per year, which is around 1% of the total NHS budget.
With the rising increase in numbers of people living with diabetes, the incidence of diabetes foot disease is likely to increase. Research illustrates that a quarter of the population of people living with diabetes have a lifetime risk of acquiring a diabetes foot ulcer. It is well accepted that over 80% of lower limb amputations in people with diabetes starts with the occurrence of a single diabetes foot ulcer. It is also well known that diabetes foot ulceration is one of the most common diabetes complication which results in hospital admissions.
Management of diabetes foot from the screening process to active management is a team effort from community or primary care to Diabetes Foot Multidisciplinary Teams, usually based within secondary care. It is well accepted that Diabetes Foot Management is not the domain of a single profession; rather it’s a partnership of teamwork comprising many professions working together with the ultimate aim of accomplishing the best outcome for the patient.
Traditionally nurses have played a significant role, with Diabetes Specialist Nurses not only actively examining feet and recognising or identifying problems and then subsequently referring to foot protection services but also playing a vital role in educating other colleagues and people living with diabetes about diabetes foot complications, prevention of foot complications and foot care. Practice nurses and Community/District Nurses have also play a similar role. In some secondary care environments, within the in-patient setting Tissue Viability Nurses play a vital role in identifying foot problems in patients with diabetes but ensuring that these patients are promptly referred to the Multidisciplinary Foot Team.
On a personal perspective from my time working within a community based high risk foot service, I was most grateful for the support of nursing colleagues for shared care of patients dressing plans. This helped to free up capacity for podiatry teams who may be small or have high patient numbers to see other patients and as such ensure that specialist care was provided to a larger population of people who required these. Nursing colleagues were also keen to try new technology with regards dressing plans and are likely to follow these plans to the letter. In such instances our nursing colleagues act as the objective eye to pick up any deterioration or new problem quickly.
For NHS staff we are currently gearing up for winter pressures on the NHS and a potential second wave of the COVID-19 pandemic. As I write this, many people are currently in the midst of a second lockdown. We are also in the month of November which is traditionally when we commemorate World Diabetes Day and celebrate all that has been achieved to better manage this condition. We use this as an opportunity to remind ourselves about the true nature of this condition and what we are currently facing on a wider perspective both nationally and globally. It also educates ourselves and people living with diabetes that not only is the condition manageable, but that there is tremendous support available for them.
During the first wave of the COVID-19 pandemic people with diabetes were identified as being at higher risk of developing severe symptoms and complications if they were infected with COVID-19. This certainly caused a certain amount of anxiety for people living with diabetes. From a diabetes foot perspective there was a quick call to action for all diabetes foot services to continue with monitoring and actively treating patients. For the most part, Diabetes Foot Services were able to deliver this. As I’ve recently found out, in some parts of the country, there was a ceasing of such activity leaving the majority of such patients to be monitored and managed within a community setting with limited or no broader consultant input. Fortunately this was not the majority of centres.
This meant that services had to very quickly adapt to the way in which they worked and there are tremendous examples of how this was done. It has to be acknowledged that digitisation helped tremendously with ensuring that patients with diabetes foot complications who were active under foot protection services were kept safe.
As part of the adapted ways of working both nurses and podiatrists using their previously established working relationships were able to rise to the new challenge of seeing this group of people. In some instances only nurses were able to access care homes and as such they became the extension of a foot multidisciplinary team to enable a joint virtual consultation to take place. Nurses were able to provide clinical information so that decisions could be made.
Additionally, nurses in primary and community care environments were pivotal in identifying, recognising and referring patients to multidisciplinary teams promptly. In other instances where specialist nurses were redeployed to other areas of working, community podiatrists very quickly upskilled in roles which were traditionally the nursing domain to ensure that patients were seen and managed accordingly. The COVID-19 pandemic certainly highlighted and taught us the importance of not only recognising and appreciating each other’s roles but also the value and importance of team-work and the strengthened working links between primary and secondary care.
Kerr M, The cost of diabetic foot disease in England, The Diabetic Foot Journal, 2019; 22 -4; pp 5-6