MANAGEMENT OF DIABETIC FOOT ULCER

Many veterans with diabetes developed peripheral neuropathy, causing sensation loss to their toes or feet that leads to poor circulation; thus, minor injuries can lead to skin breakdown, ulcer formation, and subsequent infection (VA, 2017). Also, diabetes causes slower healing and a higher chance of infections that can potentially lead to amputation of the foot or part of the foot (VA, 2017). Although the known risk of developing diabetic foot ulcer (DFU) is high, there are no universal practice guidelines specifically addressing DFU. Hence, prompt attention and consistent management of DFU, using evidence-based clinical practice guidelines (CPG), is essential to improve outcomes of reduction or prevention of complications. For this project, an evidence-based CPG was adapted, implemented, and evaluated to improve the treatment and management of geriatric veterans with DFU in the transitional, inpatient care setting using Johns Hopkins evidenced-based practice (EBP) model. In October 2019, a simple and easy-to-follow CPG algorithm of DFU was introduced to stakeholders, including Nurse Practitioners and Wound Care Consultant. A retrospective chart review was conducted two weeks post-implementation to assess adherence to CPG on pre-existing patients with DFU, followed by monthly chart review to evaluate ongoing adherence to the CPG. The evaluation was aimed at the adherence to the CPG for the following recommended practices: 1) Identifying patients with foot wounds, 2) implementing a clinical guideline for those who met the criteria, and 3) iv assessing the status of foot wound healing as a long-term goal, which was not measured due to project limitation. The data showed 90 percent CPG adherence based on the ten patients that were identified with DFUs. Although evidence-based CPG has demonstrated improvement in patient safety and health outcomes, its utility and provider adherence vary among clinical settings and providers’ discretion. A simple and easy-to-follow CPG algorithm can potentially promote adherence and facilitate implementation, and its consistent use eventually becomes a standard of practice