Assessment and Management of Foot Ulcers for People with Diabetes

Approximately 1.53 million Ontarians are living with diabetes and between 16,600 and 27,600 may develop a diabetic foot ulcer (DFU).1 The direct healthcare costs for DFU are between $320 to $400 million and indirect costs are between $35 to $60 million.1 Offloading devices (devices that relieve pressure) have demonstrated substantial cost savings. An offloading device can cost between $100 (removable cast walker) to $1,500 (total contact casting), as opposed to $70,000 per amputation. The estimated cost savings for Ontario is between $48 to $75 million per year due to saved limbs.Practice ChangesThe Home Care BPSO implemented the BPG initially in three locations and spread the practice changes across all implementation sites. Several tools were developed and implemented to support nursing care including a wound assessment document, wound care flow sheet and clinical care pathway. These strategies, resources and tools helped nurses identify when offloading devices may be beneficial for people with diabetic foot ulcers.The Home Care BPSO undertook several practice changes to support implementation and standardization including: modification of organization policies, educational training (e-learning), and other diagnostic resources (decision support tools, monofilaments and quick assessment guides).  A wound care lead role was created to provide orientation and ongoing support for health-care providers. Many nurses developed advanced competencies in wound care assessment and management. These resources supported knowledge uptake and clinical decision making.