cORONAVIRUS
Managing
foot disease
in the COVID crisis
the global challenges
One thing that's certain is the global COVID-19 situation will demand more and more hospital bed capacity to manage. What we also know is diabetes-related foot disease is a leading cause of hospital bed occupancy, and that health care professionals working in teams adhering to evidence-based DFD guideline recommendations can significantly reduce hospitalisation. So, it's vital now more than ever, for the global DFD community to potentially help the COVID-19 situation by keeping as many DFD patients out of hospital beds as possible with effective DFD care.
But what we also know is effective evidence-based DFD care is becoming increasingly challenging for global health care professionals to provide because health systems need more physical resources to manage COVID, with less physical resources then available to manage DFD. And health care professionals are telling us they need advice from DFD experts for practical tips on how to provide evidence-based DFD care in an increasingly changing landscape.
To help tackle this, DFA has joined forces with IWGDF to keep health care professionals informed with handy global COVID-19 information specifically related to DFD, and also provide national resources for our local health care professionals.
The COVID-19 crisis will demand more hospital bed capacity to manage
Diabetes-related foot disease is a leading cause of hospital bed occupancy
Evidence-based care can significantly reduce DFD hospitalisation
Australian Clinical Guide for using telehealth
For people with diabetes-related foot disease during the COVID-19 pandemic
The following is a guide to help Australian clinicians who are considering using telehealth as an alternative service type to augment the care of their patients with DFD during the COVID-19 pandemic. The guide is designed to support clinicians to consider key DFD elements to determine the suitability, preparation, consultation and documentation needed to help ensure an effective telehealth consultation.
Australian Clinical Guide for using telehealth
For people with diabetes-related foot disease during the COVID-19 pandemic
The following is a guide to help Australian clinicians who are considering using telehealth as an alternative service type to augment the care of their patients with DFD during the COVID-19 pandemic. The guide is designed to support clinicians to consider key DFD elements to determine the suitability, preparation, consultation and documentation needed to help ensure an effective telehealth consultation.
KEY POINTS TO CONSIDER BEFORE THE CONSULTATION
DETERMINE THE SUITABILITY FOR A TELEHEALTH CONSULTATION FOR YOUR PATIENT/CLIENT
• Confirm the limb &/or life threatening status and if it is appropriate to be cared for with telehealth
• Willingness to provide informed verbal or written consent to be cared for via telehealth
• Access to appropriate hardware/software required to undertake a telehealth consultation
DETERMINE IF YOU HAVE/OR CAN OBTAIN THE BELOW HISTORY FROM YOUR PATIENT/CLIENT
• General medical history, including medication and diabetes history
• DFD treatment history, including any applicable blood or microbiological results, wound dressings, antibiotics, offloading and other services used
• Recent DFD classification information, including the site, ischaemia, neuropathy, infection, size and depth status
CONTACT YOUR PATIENT/CLIENT TO DETERMINE IF YOU CAN OBTAIN THE FOLLOWING IMAGES
• Close up of the entire ulcer
• Midway shot with 4-6cm of healthy skin surrounding the ulcer
• Distant shot capturing the entire foot
• Opposite midway shot capturing the opposite side of the foot
• All images taken with good lighting or with flash to minimise any shadows
Recent chronological series of the images (preferred but not required)
If answered yes to ALL the above then the patient may be suitable for a telehealth consultation
DURING THE VIDEO CONSULTATION
SET AGREED TELEHEALTH RULES WITH YOUR PATIENT/CLIENT
• Complete introduction to telehealth consultation and seek verbal/written consent for using telehealth
• Check all personal details provided and confirm images provided for the consultation by the patient/consumer are correct
• Discuss ‘at-home’ assistance available for the consultation and troubleshoot how best to view the feet via telehealth
DISCUSS GENERAL AND PSYCHOLOGICAL HEALTH WITH YOUR PATIENT/CLIENT
• Discuss how your patient/client is coping and what support and assistance is available at home
• Discuss any fears/concerns for both foot-related and mental health
• Use the time to develop a rapport as your patient/client may feel more comfortable conversing in their own environment
VIEW FEET AND ASK YOUR PATIENT/CLIENT THE FOLLOWING
• To remove shoes and socks and position feet so you can see the ulcer
• To remove dressing so you can see both the dressing, the dressing in contact with the ulcer, and the ulcer
• Ask about any recent changes to the ulcer, including redness, swelling, pain, discharge, leakage, odour, difficulty with dressing changes, and offloading devices
• Show you how dressings are applied and self-care routine for the feet and ulcer: then provide tips if/where applicable
• Demonstrate walking using prescribed offloading device: then provide tips if/where applicable
NEXT STEPS
ADVICE
• Discuss the next steps to care for the ulcer/DFD before the next consultation, including dressing changes, offloading, and who/when to contact if the foot status changes
• Offer further resources/links that can help with ulcer prevention or healing
• Check your patient/client understand or have a level of understanding and ask to repeat these next steps in their own words
REBOOKING
• Ask your patient/client if they would be happy to undertake a telehealth consult in the future
• Determine if the next consultation is appropriate for telehealth or face-to-face
• Rebook your patient/client for the next consultation via face-to-face or telehealth
DOCUMENT
• Document all the above steps in the your patient/client medical record as you normally would and include images supplied
• Highlight that the consultation was undertaken via telehealth and that information and technology was used
NOTE: This information should not be seen as medical advice and we do not assume liability or responsibility for damages or injury to any person or property arising from any use of any information, idea or construction in this guide.
Australian Clinical Triage Guide
For people with diabetes-related foot disease during the COVID-19 pandemic
The following clinical guide is to help Australian clinicians who are triaging and caring for people with DFD during the escalating COVID-19 situation. This guide is designed to support iHRFS and DFD clinicians, as well as primary care providers and community podiatry, on suggested acceptable alternative processes of care provision. They include considerations for service type and frequency according to factors such as the patient’s limb and/or life threatening status, local staffing and resource availability, as well as for minimising risk of COVID-19 infection.
FOOT DISEASE CONDITION(S) | MAINTAIN USUAL TRIAGE PLAN | BEST PRACTICE CLINICAL CARE IN NON COVID-19 CRISIS | COVID-19 POTENTIAL IMPACT ON CLINICAL CARE* |
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Refer immediately to
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aTELEHEALTH
Options may include telephone, store-and-forward clinical or radiological images, videocall and other remote monitoring methods (e.g. foot temperature monitoring, step activity monitoring etc.). Telehealth can potentially be funded by Medicare, please refer to Medicare Telehealth items11
bHOME VISITS
Clinician visits the patient’s home to perform treatment. This can potentially be funded by under Medicare, please refer to
Medicare Chronic Disease Management
items12
iHRFS
Inter-disciplinary High Risk Foot Service (or equivalent multiple disciplines that include at a minimum a doctor, nurse and podiatrist with direct access to a surgeon, all of whom are experienced in diabetes-related foot disease care).
VERSION 1.0: 07.04.2020 LEGEND: Adapted from Rogers et al 2020. *COVID-19 potential impact in terms of local COVID transmission and/or impacts on local staffing and resource availability may differ across jurisdictions.
Australian Clinical Triage Guide
For people with diabetes-related foot disease during the COVID-19 pandemic
The following clinical guide is to help Australian clinicians who are triaging and caring for people with DFD during the escalating COVID-19 situation . This guide is designed to support iHRFS and DFD clinicians, as well as primary care providers and community podiatry, on suggested acceptable alternative processes of care provision. They include considerations for service type and frequency according to factors such as the patient’s limb and/or life threatening status, local staffing and resource availability, as well as for minimising risk of COVID-19 infection.
What's happening
Around Australia?
That's a very good question & one posted on our Facebook page. How has your department/ team adapted? What are your current challenges? Click on the links below to read how some on our high risk foot services around Australia are facing the COVID-19 challenges & restrictions.
Perth High Risk Foot Service
Brisbane High Risk Foot Service
Adelaide High Risk Foot Service
Global DFD Q&A
We’ve teamed up with IWGDF and DFoot International to launch the IWGDF COVID and DFD webpage to give practical answers from global DFD experts to help you do the best you can for your DFD patients during the pandemic.
Global DFD Q&A
with International Experts
We’ve teamed up with IWGDF and DFoot International to launch the IWGDF COVID and DFD webpage to give practical answers from global DFD experts to help you do the best you can for your DFD patients during this pandemic.