Save A Leg: Building Integrated Diabetes Foot Services in Western Sydney

Clare McGloin Senior Podiatrist Blacktown & Mt Druitt Hospitals WSLHD

Case for Change

If you live in Western Sydney you are 2 -3 times more likely

to develop Diabetes

50% of people in our LHD are at risk of developing Diabetes 15% of people have Diabetes

Summary of Key Solutions

• Solution 1 : Development & Implementation Of Two Stage Diabetes Foot Screening Tool

• Solution 2 : Practice Nurses to provide Diabetes Foot screening

• Solution 3: Electronic Referral Templates and Pathways

Implementation of changes NEW! 60 second Minimum Standard Screening Tool

Implementation of changes Education infographic flyer on diabetes foot facts and care

Monofilament

Implementation of changes Electronic referral template to HRFS Clinics

Summary

• Save A Leg developed a 60-second diabetes foot screening tool

• Educated patients, nurses and clinicians on the importance of using the tool and conducting regular foot checks at least annually.

• Electronic referral templates and clinical pathways were also developed, to facilitate the improvement of timely access to hospital foot services.

• Areas to improve:

– Roll out of implementation to wider community in Western Sydney

Blacktown & Mt Druitt HRFS Team

• Podiatrist – Clare McGloin • Wound Care Nurse –Stacey Harrison, Lesley Jack • Diabetes Educator – Sian, Sonya, Annette (IC) • Dietitian – Sonia, Amber (IC) • Vascular Surgeon – Tom Daly, Mark Malouf, Vascular Fellow

(theatres BDH, WMH, Mt Druitt, private) • Endocrinologist – Rajini Jayaballa (IC) • ID Consultants – Shobini Sivagnanam, Ravi Dotel • Administration – Steve (Therapies), John Cruz (IC)

IC = Integrated Care

Blacktown & Mt Druitt HRFS Clinics

• Podiatrist Mon, Wed, Thurs, Fri

• Wound Care Nurse weekly Wed Ulcer Clinic

• Diabetes Educator weekly Wed

• Dietitian weekly Wed (not co-located)

• Vascular Surgeon fortnightly Wed

• Endocrinologist weekly Wed

• ID Consultants weekly Wed (afternoon clinic)

• Administration Mon-Fri (Steve no co-located)

Progress in 2016

• Silhouette camera (July)

• Outreach to Mt Druitt (July)

• Increase in Podiatry to full time service

• Wound CNC (September)

Potential opportunities in 2017

• Additional Surgical time

• Endovascular services at BDH

• Ulcer Clinic weekly (medical support)

Summary

• The HRFS at Blacktown meets the minimum or best practice standard for most of the NSW ACI High Risk Foot Services Standards

• Areas to improve:

- Formal mechanism to identify patients who present to ED

- Obtain allocated space to meet OH&S standards

- Access to computerised gait analysis and in-shoe pressure analysis

- Maintain an electronical database and monitor KPIs