QI In Action: Introducing diabetes foot assessments on Country

Read this impactful project carried out by V-QIL participant, Ms Fiona Miles A/Safety and Quality NMC, NT Health.

The Improvement Academy Quality Improvement Lead (QIL) Training Program is a 9-month training program designed to empower participants with the skills and knowledge to drive positive change in healthcare. Read below to learn how V-QIL participant, Ms Fiona Miles worked towards introducing foot assessments to all patients admitted with diabetes complications.

Background

A Darwin study found a 25% mortality rate at five years for diabetic foot ulcers(1), and in Central Australia, 60% of Indigenous participants reported foot pain, of which 70% were untreated (2). In East Arnhem, diabetes complications are listed as the fourth most preventable reason for hospital admissions (3). Another study found that 84% of lower limb amputation patients identified as Aboriginal Australians (4).

Project Summary

The Gove District Hospital (GDH) services over 14,000 people and has no visiting podiatry or foot assessments on campus, often resulting in poor outcomes for clients with diabetes in this remote community. This project aimed to introduce a foot assessment to all patients admitted with diabetes complications or those with diabetes and a lower limb wound within 48 hours of admission.

Interviews with patients revealed dissatisfaction with a service at GDH not being available, and patients revealed being advised to see a podiatrist while on holidays. Sessions with clinicians revealed that none were performing basic foot checks. GDH did not have equipment for this task.

A large part of this project was to design a user-friendly assessment form. Three forms were distributed to clinicians for feedback. Input was sought from senior podiatrists. Physical and visual assessments alone needed to provide enough information for risk rating to allow for times when an interpreter was unavailable. Keeping the form to one page was also vital to improve acceptability.

The form was trialled on four occasions and minor changes were made each time. One of these was making all the ‘yes’ answers red flags so that a glance down the line would elicit this information.

Results

Initially, data collection relied on manual entry; however, the recently introduced electronic clinical information management system will capture this data when assessments move from paper to electronic. After full implementation, the numbers of patients with diabetes admitted will be compared to the number of diabetic foot assessments performed. Regular in-service training is now in place for all clinical staff to improve uptake. Checking admissions and assisting with foot assessments is occurring, and doctors are now asking for their patients to be assessed.

Diabetic foot checks are now available at GDH, however not every patient who meets the criteria is receiving one yet. The high turnover of clinicians has affected the uptake of this service, and other competing projects have severely reduced education opportunities.

Referrals created under this program will now form part of the business case to obtain a visiting podiatry service for GDH.

Want to see more projects like this? Read our Quality Improvement Lead (QIL) Program: Project Summaries 2021-2023 Booklet.

Join our QIL Training Program 2024

Discover excellence and transformation with our practitioner and lead level training in 2024: Virtual Quality Improvement Lead (QIL) Training Program are open for registrations now.

Participants will have the opportunity to undertake a work-based improvement project while being guided by our expert faculty of clinicians. V-QIL is a 9-month program broken up into 6 modules that delivers methods, tools and coaching to equip participants with the skills to become an improvement leader.

Sources:

ArnhemRegional-Data-Profile_FINAL.pdf 2. Jeyaraman K, Berhane T, et al. Mortality in patients with diabetic foot ulcer: A retrospective study of 513 cases from a single centre in the Northern Territory of Australia. BMC Endocr Disord. 2019;19(1): https://doi.org/10.1186/s12902-018-0327- 2 3.

Sadler S, Gerrard J, et al. Aboriginal and Torres Strait Islander peoples’ perceptions of foot and lower limb health: A systematic review. J Foot Ankle Res. 2022;15(1): https://doi.org/10.1186/s13047-022- 00557-0 4.

NT Primary Health Network, Rural Workforce Agency NT. East Arnhem Region data report: Overview of selected demographic and health data for the East Arnhem region of the Northern Territory. 2020. https://www.ntphn.org.au/wpcontent/uploads/2021/06/East

Stuart L, Kimmel L, et al. Incidence of lower limb amputation in Central Australia. Aust Health Rev. 2021;45(3). https://doi.org/10.1071/ah20182