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NHS Diabetes backs foot screening test for inpatients

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A simple screening tool can help nurses reduce the risk of diabetes patients developing hospital-acquired foot lesions and heel ulcers, according to its developers.

The “Foot of the Bed” form incorporates three elements: a checklist of previous history plus results from daily heel checks and a new screening method called the Ipswich Touch Test.

The test involves very lightly touching three toes on each foot – the first, third and fifth. If the patient did not feel when touched on two or more, then they are considered to be at higher risk of a diabetic foot ulcer.

Both the test and the form were developed by clinicians at Ipswich Hospital NHS Trust, who said the screening method had seen hospital-acquired heel ulcers reduced by more than 50% over 10 months. 

Dr Gerry Rayman, who led the initiative at Ipswich Hospital, said: “The FoB form has increased foot examinations at Ipswich Hospital from 27% to 55%, 75%, 80% and 79% at three, four, five and 10 months respectively and following its inclusion as part of the quality governance plan for Ipswich Hospital compliance now exceeds 85%.

“Importantly, there has been a reduction in hospital-acquired heel ulcers of more than 50%.”

Chris Kerry, a diabetes nurse specialist at the trust, said it had been “very positively” received by nurses, despite concerns it would be viewed “as yet another task and form filling exercise”. 

He said: “Importantly, we showed them that the test was simple and quick to perform and that it could be easily included as part of the patient’s personal care.”

The move comes after the National Diabetes Inpatient Audit 2010 found that 2.2% of people with diabetes acquired a foot or heel ulcer while in hospital, and less than a quarter of inpatients (22.6%) had their feet examined in the 24 hours after admission.

Nurses at other hospitals are being encouraged to use the tool as part of a two year study to see if its success at Ipswich can be replicated elsewhere. Its roll out is supported by NHS Diabetes, Diabetes Specialist Inpatient Nurse Forum and Sanofi Diabetes.

An information pack is available from the NHS Diabetes website.


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