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New guide promotes root cause analysis to reduce diabetes related amputations

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A guide has been published by Diabetes UK to encourage nurses and other healthcare professionals to use root cause analysis to help reduce the number of unnecessary diabetes-related amputations.

The charity said such analysis helped reduce future amputations by determining the extent that an amputation was avoidable or unavoidable, and whether or not it was the best possible outcome.

“It replaces the sense of disinterest, even nihilism about this challenging medical problem”

Richard Paisey

If it was avoidable, completing an analysis would help identify what changes were required to reduce the likelihood of the same event happening again, said the charity.

The new root casue analysis guide is based on an existing diabetes foot care resource pack developed by the South West Cardiovascular Clinical Network.

It is also the result of discussions with other experts including podiatrists, members of the Northern Footcare Network and a practice nurse.

The guide includes a data collection template, a primary care data collection tool and a reporting template.

Dr Richard Paisey, diabetes footcare lead at South West Cardiovascular Clinical Network and one of the team who worked on the new guide, said it should provide each area with an “accurate and up-to-date picture” of the proportion of major amputations that were potentially avoidable.

“Ultimately, using root cause analysis should highlight best practice and also facilitate follow up of missed opportunities in provision of care in each case,” he said.

“There may be generic problems in delivering foot care in an area which could be addressed by constructive discussion with all care providers involved,” he said. “Changes required in foot care provision are often cost neutral short term and longer term will be cost saving.”

Dr Paisey added that improving the integration of care for diabetes patients with foot problems through route cause analysis “enhanced the whole service”.

“It replaces the sense of disinterest, even nihilism about this challenging medical problem, with satisfying collaboration and a sense of pride in a job well done,” he said.

Bridget Turner, director of policy and care improvement at Diabetes UK, said: “This guide builds on the work of others and is a really important step in aiming to avoid the current variation in the number of amputations around the country.

Diabetes UK

Guide aimed at reducing diabetes related amputations

Bridget Turner

“Root cause analysis is a vital part of scrutinising what can go wrong and providing essential learning. It is this learning that informs the improvements needed to ensure people at risk of amputation are provided with the best possible information, education and care throughout their journey,” she said.

Diabetes UK highlighted that the risk of amputation could be reduced through provision of an integrated foot care pathway.

It added that all diabetes patients should have a quality annual foot risk assessment and, if at increased risk, be referred for assessment by trained staff in community foot protection services and have quick access to multidisciplinary specialist foot care teams.

There was still considerable variation in outcomes and processes across the diabetes foot care pathway, from the number of foot checks delivered in primary care, and the quality of them, to major and minor amputation rates, warned the charity.

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