Practice Recommendations

Practice Recommendation

Level of Evidence

Assessment

1 .0 Obtain a comprehensive health history and perform physical examination of affected limb(s).

Ib – IV

1 .1 Identify the location and classification of foot ulcer(s) and measure length, width and depth of wound bed.

Ia – IV

1 .2 Assess bed of foot ulcer(s) for exudate, odour, condition of peri-ulcer skin and pain.

IV

1 .3 Assess affected limb(s) for vascular supply and facilitate appropriate diagnostic testing, as indicated.

III – IV

1 .4  Assess foot ulcer(s) for infectionG   using clinical assessment techniques, based on signs and symptoms, and facilitate appropriate diagnostic testing, if indicated.

Ia

1 .5 Assess affected limb(s) for sensory, autonomic and motor changes.

IIa

1 .6 Assess affected limb(s) for elevated foot pressure, structural deformities, ability to exercise, gait abnormality, and ill-fitting footwear and offloading devices.

Ia – IV

1 .7 Document characteristics of foot ulcer(s) after each assessment including location, classification and any abnormal findings.

IV

Planning

2 .0 Determine the potential of the foot ulcer(s) to heal and ensure interventions to optimize healing have been explored.

IV

2 .1 Develop a plan of care incorporating goals mutually agreed upon by the client and health-care professionals to manage diabetic foot ulcer(s).

IV

2 .2 Collaborate with the client/family and interprofessional team to explore other treatment options if healing has not occurred at the expected rate.

IV

2 .3  Collaborate with client/family and the interprofessional team to establish mutually agreed upon goals to improve qualityG of life if factors affecting poor healing have been addressed and complete wound closure is unlikely .

IV

Implementation

3 .0 Implement a plan of care to mitigate risk factors that can influence wound healing.

IV

3 .1 Provide wound care consisting of debridement, infection control and moisture balance where appropriate.

Ia – IV

3 .2 Redistribute pressure applied to foot ulcer(s) by the use of offloading devices.

Ia

3 .3 Provide health education to optimize diabetes management, foot care and ulcer care.

Ia

3 .4 Facilitate client-centred learning based on individual needs to prevent or reduce complications.

III

Evaluation

4 .0 Monitor the progress of wound healing on an ongoing basis using a consistent tool, and evaluate the percentage of wound closure at four weeks.

Ib

4 .1 Reassess for additional correctable factors if healing does not occur at the expected rate.

IV