By screening feet, they’re hoping to prevent amputations.

For over a year now, Wakaw Primary Health has been conducting a project to ensure more clients with diabetes receive regular foot screenings in the hopes of preventing below-the-knee amputations. 

Feet.

By focusing on foot care, the Wakaw Primary Health team is trying to prevent below-the-knee amputations for people with diabetes.

It’s commonly known that foot ulcers are a frequent complication of diabetes – the lifetime risk for foot ulceration in people with diabetes is 15 to 25 per cent. And there is a higher risk for an ulcer leading to a below-the-knee amputation for those diabetes clients who have not been screened for foot complications. But a regular foot screen as part of a regular diabetic checkup can help to keep feet happy and healthy.

With the prevalence rate for diabetes in Saskatchewan increasing steadily each year – provincial rates have risen from 29.2 persons per thousand in 1996 to 52 in 2005 – the Primary Health team in Wakaw wanted to create a better health model for those living with diabetes in order to prevent amputations.

A team approach was taken in creating this model, as there is strong evidence to indicate that foot care is best delivered when it is provided by an interdisciplinary team. That team should closely involve the person with diabetes and his or her family, along with health care professionals from different specialties.

The first step in developing such a team in Wakaw was to identify the nature of each department’s interaction with foot care and diabetes, and the communication flow between departments.  The team facilitator with the Wakaw Primary Health team began to build process maps of Home Care, Chronic Disease Management, Nurse Practitioner, and Nursing.  Through this process, gaps in service, lack of access and poor communication were identified as issues and improvement strategies began to emerge.

A referral process was developed and implemented which would allow primary care providers to send clients to the Primary Health Registered Nurse for foot screening and education. And a poster display was set up in the hallway to inform people about the service, and attract them to it.

Home Care and Chronic Disease Management continued to screen feet at appointments and developed a communication strategy to promote follow-up with a client’s primary care provider by providing them with a copy of the foot screen, and a date for the next screening.

A postcard was also created in collaboration with the LiveWell Chronic Disease management program. This postcard was distributed widely throughout the Wakaw community, increasing public awareness of services available, and acting as an invitation for people to get their feet checked at their next diabetes appointment.

An informal chart audit of the Wakaw Primary Health Clinic prior to the start of this initiative showed that the majority of people with diabetes had not had a foot screen documented in the preceding 12 months.  A second audit completed a year after the implementation of the diabetes foot screening project showed a marked improvement in foot screens and other chronic disease management benchmarks such as ABCs.

“Nearly every person with diabetes in the Wakaw community has had a foot screen completed in the past year,” noted Kari Wuttunee, Aboriginal Community Developer with Primary Health.

Referral numbers have also increased, and people have become more interested in self-care, as they’re making their own follow-up and post-procedure appointments.  Communication between departments – home care, clinic staff, physicians and Chronic Disease Management – have also markedly improved as staff know where to refer clients to, when tests and scans were completed, and have up-to-date health information.

The Wakaw Primary Health Team continues to meet regularly to move the issue of foot care and diabetes management in a positive direction in the community. The team recognizes that only through an interdisciplinary team approach, addressing the diversity of possible foot problems in people with diabetes, can the desired reduction in amputation rates be achieved.