INTEGRATED RETINAL AND FOOT SCREENING 3 Areas covered

INTEGRATED RETINAL AND FOOT SCREENING

3 Areas covered All patients from Aberdeen city GP practices attend the static base, at the David Anderson Building. l Patients from Aberdeenshire and Moray practices are screened closer to home, by the mobile units. l

Screening Set up Foot screening introduced April 2009 l Currently offered to patients from Aberdeen city GP’s practices, (approx. 1/3 of Grampian diabetic population). l

Why are we foot screening? l l l Easier to provide training and QA to a small team. Previous screenings not always recorded Foot risk stratification not always available.

Training and QA l Training for staff l QA on a regular basis l QA and audit after first year l Patient preference

PREREQUISITS to provide a truly integrated screening l 2 nurses l 2 rooms at each venue l If not, delay in screening process l Time wasting for department and patient

Rolling out the service l Aberdeenshire and Moray integrated screening requirements l Extra staff l 2 rooms in the location l Difficulty obtaining 1 room allocation

Alternative Eyes and feet done by 1 screener l Longer appointment time l Back log of patients l Model would not achieve targets of 80% patients being screened annually l

How we foot screen? l 1 st line screening tool l Risk assessment tool l Referral pathway in place

Foot pulses l Dorsalis pedis l Posterior tibial

Monofilaments l 10 g CALIBRATED monofilament l 3 or more sites absent = significant neuropathy

Other observations l Significant callous l Significant deformity

Any other information

Results

RESULTS ENTERED LIVE ON SCI DC FOOT SCREENING TOOL

Result Available

Risk category l LOW RISK l MODERATE RISK l HIGH RISK

Education Leaflets

Ulceration & Amputation

National Foot risk Stratification and Triage

Referrals forwarded to Podiatry Department Referrals received from Integrated Screening Clinic Low Risk Not seen by podiatry Referral via GP if Podiatric need Annual integrated Screening Education Moderate Risk Not seen by podiatry department Referral Via GP if Podiatric need Yearly screening @ Integrated Screening Education Rapid Access Details High Risk Education Rapid Access direct to podiatry. Care pathway is made up Letter is sent to Integrated screening To say that referral received.

Integrated Screening Foot Referrals received from DRS HIGH RISK Referral checked on Podis DECEASED Referrals for Archiving Already an existing patient Check treatment date. If Date not current Appointment arranged for IFS Assessment clinic No previous referrals made. Appointment arranged for IFS Assessment Clinic.

Assessment of referrals Referrals are Re assessed Low or Moderate Risk, Register patient details On Podis Re assessed as HIGH Risk. Letter to GP to inform of proposed treatment plan

Outcome of re assessment Risk Stratification stated and action taken is recorded on Podis Update SCI DC form and letter sent to GP Low Risk Patient discharged if no treatment required Moderate Risk If patient needs care, notes Are sent to the relevant clinic with a view to discharge HIGH RISK Notes referred to the Highly Specialised Diabetes podiatrist. For review. Rapid Access advice is given Patient reviewed as necessary

Audit of service users

Ages of service users

Audit of service users

Preferred Screening Option

Targeted Information

PATIENTS VIEWS

Recap Service is well liked by the patients. l Service delivery is difficult to organise and deliverer. l Heavily dependant on having access to 2 rooms in each venue. l Heavily dependant on having the correct level of staff available to operate the service as an integrated screening. l

Positive comments from patients l l l l Good idea to do the 2 tests at the same time. I liked getting things over and done with at the same time. Seems very efficient to me. The Integrated screening works well. Fantastic Service Full marks for keeping to time (in fact early). Great Service as always at this site. Very relaxed and everything explained. Very timely appointments and very nice nurses.

Negative comments l l l Parking at the David Anderson building is horrendous and I am a blue badge holder. Car parking space terrible. No Parking spaces (small issue) you could mention it on letter going out to patients that this could be a problem. Appointments to fit round work commitments can be hard to get Past records at hand for staff, i. e. nurse unaware I only had one working eye otherwise service very good.

THANK YOU