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 |
Practice Recommendations
Chronic Disease
Assessment and Management of Foot Ulcers for People with Diabetes - Second Edition
Practice Recommendations