Shared Care Pathway for Management of
Foot Ulceration for Patients under the
Care of Podiatry and Community Nursing
Services
Unique Identifier:
ALTC/SOP/017
Version Number:
1
Type of Update / Status: Ratified - New Document
Divisional and
Podiatry and Community Nursing, Adults and Long Term
Department:
Conditions
Author / Originator and
Yasmin Mulhall – Clinical Care Coordinator – Central
Job Title:
Neighbourhood
Joanne Fear – Team Leader – Central Neighbourhood
Maria Remo Loida – Advanced Podiatrist - Blackpool
Emma Phillips – Advanced Podiatrist – Blackpool
Debbie Wilford – Advanced Podiatrist - Wyre
Susan Baldwin – Senior Community Nurse – South Shore
Neighbourhood
Chloe Cross – Community Nurse – North Shore
Neighbourhood
Emma Clarke – District Nurse – Central West Neighbourhood
Replaces:
New document
Description of
N/a
amendments:
Approved by:
Adults and Long Term Conditions Divisional Policy Group
Approved Date:
06/11/2020
Issue Date:
06/11/2020
Review Date from Date
1 Year
2 Years
3 Years
4 Years
5 Years
of Approval:
☐
☐
☒
☐
☐
06/11/2023
Version Control Sheet
This must be completed and form part of the document appendices each time the
document is updated and approved
Date
dd/mm/yy Version
Author
Reason for changes
06/11/20
1
Yasmin Mulhall – Clinical Care
New document
Coordinator – Central Neighbourhood
Joanne Fear – Team Leader – Central
Version Control Sheet Neighbourhood
Maria Remo Loida – Advanced
Podiatrist – Blackpool
Emma Phillips – Advanced Podiatrist –
Blackpool
Debbie Wilford – Advanced Podiatrist –
Wyre
Susan Baldwin – Senior Community
Nurse – South Shore Neighbourhood
Chloe Cross – Community Nurse –
North Shore Neighbourhood
Emma Clarke – District Nurse – Central
West Neighbourhood
Consultation / Acknowledgements with Stakeholders
Name
Designation
Date Response
Received
Lorraine Wilkinson
Head of Locality
6/8/2020
Jan Bamber
Complex Care Coordinator and NMP Lead
5/8/2020
James Earle
Team Leader
5/8/2020
Kay Dalton
Team Leader
6/8/2020
Blackpool Teaching Hospitals NHS Foundation Trust
ID No. ALTC/SOP/017
Title: Shared Care Pathway for Management of Foot
Revision No: 1
Next Review Date: 0611/2023
Ulceration for Patients under the Care of Podiatry
and Community Nursing Services
UNCONTROLLED COPY WHEN PRINTED
Current Version held on the Intranet
Page 2 of 15
link to page 1 link to page 2 link to page 4 link to page 4 link to page 4 link to page 4 link to page 4 link to page 4 link to page 5 link to page 6 link to page 8 link to page 9 link to page 9 link to page 10 link to page 12 link to page 14
CONTENTS
Version Control Sheet .......................................................................................................... 1
Consultation / Acknowledgements with Stakeholders .......................................................... 2
1
Introduction / Purpose ................................................................................................. 4
1.1 Purpose ................................................................................................................... 4
1.2 Introduction ............................................................................................................. 4
2
General Principles / Target Audience .......................................................................... 4
3
Responsibilities (Ownership and Accountability) ......................................................... 4
3.1 Al Health Care Professionals involved in wound management .............................. 4
3.2 Community Nurses / Treatment Room Nurses ........................................................ 5
3.3 Podiatrists ............................................................................................................... 6
4
The Care Pathway ....................................................................................................... 8
5
Training ....................................................................................................................... 9
5.1 Monitoring (Including Standards) ............................................................................ 9
6
References and Associated Documents ................................................................... 10
7
Definitions and Abbreviations .................................................................................... 12
Appendix 1: Equality Impact Assessment Form ................................................................. 14
Blackpool Teaching Hospitals NHS Foundation Trust
ID No. ALTC/SOP/017
Title: Shared Care Pathway for Management of Foot
Revision No: 1
Next Review Date: 0611/2023
Ulceration for Patients under the Care of Podiatry
and Community Nursing Services
UNCONTROLLED COPY WHEN PRINTED
Current Version held on the Intranet
Page 3 of 15
1 Introduction / Purpose
1.1 Purpose
The purpose of this standard operating procedure is to create a pathway for shared care
between podiatry services and community nursing for patients with foot ulceration. This
wil help patients to receive appropriate care in a timely manner, and ensure that foot
wounds are managed effectively and there are no delays in treatment.
1.2 Introduction
It was identified that there was a need to standardise practice across disciplines of Nursing
and Podiatry, to improve patient outcomes.
Nurses have specialist knowledge in the management of patients with ulcers and this
combined with the specialist knowledge of sharp debridement skil s and off-loading
techniques by Podiatrists means a natural combined approach would greatly benefit
patient care resulting in improved quality of life and improved outcomes for patients.
Current government legislation promotes multidisciplinary integrated working as it is known
that this will promote improved patient outcomes (1).
A review group was formulated consisting of Podiatrists and Community Nurses from the
Blackpool Fylde and Wyre localities. Current practice was identified including variances in
practice between localities and it was identified that there was no current pathway in place.
The pathway is designed to streamline care for patients with foot ulceration or pressure
ulceration (foot or heel), peripheral vascular disease and high risk diabetic patients.
2 General Principles / Target Audience
The pathway wil be used by all community nursing teams and podiatrists involved in the
care of patients with foot ulcers.
3 Responsibilities (Ownership and Accountability)
3.1 Al Health Care Professionals involved in wound management
In order to implement this pathway in clinical practice all Health Care Professionals
involved in wound management wil :
•
Identify learning needs in relation to wound management as part of their
development requirements.
•
Access training as outlined in section 5.0 in order to maintain their competence and
safe practice.
•
Liaise with other members of the multi-disciplinary team in order to plan and co-
ordinate appropriate wound management for patients.
•
Undertake a holistic assessment of the patient to identify potential factors that may
affect wound healing and wherever possible take action to maximise potential for
healing.
Blackpool Teaching Hospitals NHS Foundation Trust
ID No. ALTC/SOP/017
Title: Shared Care Pathway for Management of Foot
Revision No: 1
Next Review Date: 0611/2023
Ulceration for Patients under the Care of Podiatry
and Community Nursing Services
UNCONTROLLED COPY WHEN PRINTED
Current Version held on the Intranet
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Accurate documentation must be completed at initial presentation and each visit thereafter
should deterioration occur and must include the following:
•
Location of wound (on body / foot map)
•
Date of onset
(to be documented at initial visit and on the front of each consecutive wound chart)
•
Length
•
Width
•
Depth
•
Undermining area
•
Wound bed descriptors / tissue type
(e.g. Granulation, slough, necrosis, tendon, bone etc.)
•
Exudate (type and amount)
•
Presence or absence of clinical signs of infection
(including details of wound swab culture and sensitivity)
•
Pain Score
•
Wound photography as per Medical Photography Policy (CORP/PROC/002) (2).
Clinicians who have been issued with a Trust-encrypted mobile phone that has been
enabled for use with the ‘WABA MIM’ must ensure that the appropriate level of
consent has been obtained prior to the taking of photographs and that this has been
documented. The deleting of images once the images have been uploaded from the
Trust device to the WABA MIM / EMIS wil be automatic
•
Plan of care / treatment aims
Al health care professionals have a duty to ensure appropriate actions are taken following
reassessment. Where any concern is identified or if a wound is failing to heal the
healthcare professional should seek advice from a senior within the team and if
appropriate escalate a referral to the Tissue Viability Service.
3.2 Community Nurses / Treatment Room Nurses
Community Nurses and Treatment Room Nurses wil :
•
Undertake holistic assessment of the patient with foot ulceration to include
assessment of vascular status using ankle-brachial pressure index (ABPI) or Toe-
brachial pressure index (TBPI), unless already completed by vascular or podiatry)
and
•
Waterlow risk assessment to be completed and updated as per trust policy (3)
•
Ensure Care Plan is implemented
•
Patient / carer information (4) wil be provided around Pressure Ulcer Prevention and
Management Guidelines
Blackpool Teaching Hospitals NHS Foundation Trust
ID No. ALTC/SOP/017
Title: Shared Care Pathway for Management of Foot
Revision No: 1
Next Review Date: 0611/2023
Ulceration for Patients under the Care of Podiatry
and Community Nursing Services
UNCONTROLLED COPY WHEN PRINTED
Current Version held on the Intranet
Page 5 of 15
•
Skin assessment to be completed – to include all potentially vulnerable areas
•
Support surfaces to be assessed (and provision of equipment arranged if required)
•
Advise Patient Keep moving – if patient is nursed in bed a repositioning regime to be
established personalised to the patient and pressure relieving advice to be given
•
Incontinence is assessed and appropriate management plan is implemented
•
Nutrition and Hydration assessment (MUST) completed and appropriate action plan
implemented and referral on to dietitian is initiated if required.
•
A wound assessment tool is completed and an appropriate wound management care
plan is implemented to include:
(a) Skin care including care of the foot and emollients prescribed
(b) Dressing choice and rationale for treatment
(c) Frequency of dressing change
(d) Evaluation of wound management and wound progression.
•
Refer all patients with foot ulceration to podiatry for further assessment of the foot as
per the following Shared Care Pathway for Foot Ulceration (Section 4.0).
•
Complete an untoward incident report (5) for all patients with pressure ulceration to
the heel or foot and follow relevant guidelines to ensure that the patient receives
appropriate assessment and management.
•
Documentation of Consultant involvement where applicable (e.g. Vascular, Diabetic
MDT, Renal etc.)
3.3 Podiatrists
Podiatrists will:
•
Complete holistic assessment of the patient with foot ulceration to include
assessment of vascular status and neurological assessment where appropriate
unless already completed by another service (e.g. Vascular Service, Community
nursing)
•
Refer the patient to appropriate Community Nursing Team for ongoing care as per
the Shared Care Pathway For the management of Foot Ulceration. Shared care may
also be appropriate for some patients following nail surgery.
•
Where minor cuts are caused in the process of trimming nails, the podiatrist should
assess appropriateness of self-care by the patient (where appropriate). If the patient
is unable to self-manage, then the podiatrist should maintain their duty of care to the
patient and continue treatment until healed.
•
Assess the patient’s suitability for sharp debridement, off-loading, bio-mechanics and
discuss frequency of podiatry input required with appropriate nursing staff who wil
devise and implement the plan of care.
•
Ensure that patients who have plantar surface ulceration have adequate off-loading
prior to referral to Ambulatory Services in order to prevent potential for deterioration.
Blackpool Teaching Hospitals NHS Foundation Trust
ID No. ALTC/SOP/017
Title: Shared Care Pathway for Management of Foot
Revision No: 1
Next Review Date: 0611/2023
Ulceration for Patients under the Care of Podiatry
and Community Nursing Services
UNCONTROLLED COPY WHEN PRINTED
Current Version held on the Intranet
Page 6 of 15
•
Complete an untoward incident report (5) for all patients with pressure ulceration to
the heel or foot (unless already completed by another service) and follow relevant
guidelines to ensure that the patient receives appropriate assessment and
management.
Blackpool Teaching Hospitals NHS Foundation Trust
ID No. ALTC/SOP/017
Title: Shared Care Pathway for Management of Foot
Revision No: 1
Next Review Date: 0611/2023
Ulceration for Patients under the Care of Podiatry
and Community Nursing Services
UNCONTROLLED COPY WHEN PRINTED
Current Version held on the Intranet
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4 The Care Pathway
New Referrals are received by appropriate services
Initial assessment undertaken by the service receiving the referral
Initial presentation of foot ulcer (below the malleolus) consider joint working
pathway below
Assessment of vascular status to include ABPI / TBPI
Non Urgent:
Holistic assessment and prescribe treatment plan,
consider:
All foot ulcers:
Follow clinical wound management guidelines, reassess
Urgent
at every visit for evidence of infection, complete wound
Absent foot pulses
assessment documentation every week
Plan of care to include: debridement (if applicable and
Ischaemic rest pain
dependent upon normal ABPI), wound management, off-
Loss of function
loading or footwear, skin care, management of factors
Hot/swollen foot
which may delay healing
Patient unwell:
Special Risks:
pyrexia or flu like symptoms
Diabetic? – urgent referral to diabetic MDT &
Take photographic evidence
Advanced podiatrist for advice
Discuss with Advanced
Pressure Ulcer? –UIR to be completed at initial
Podiatrist for advice
presentation by Podiatrist / Nurse Photograph and
Liaise with on call
complete wound assessment documentation
vascular services
Increased risk of infection? Rheumatoid / Diabetes /
Immunosuppressants / Peripheral Vascular Disease
A new or deteriorating ulcer below the malleolus
Urgent
consider joint visit nursing/podiatry or consultation to
Nurse / Podiatrist seeing the
provide a shared plan of care
patient takes immediate
appropriate action e.g. admit
to hospital (999) or contact GP
Coordinator for shared care should be community
/ GP on-call for advice /
nurse unless explicitly agreed otherwise.
contact Vascular Nurse
Specialist for admission /
advice
Negotiated plan of care to focus on the needs/benefits
to the patient.
Community Nurse undertakes ongoing wound assessment and
management including responsibility for prescribing.
Podiatrist provides specialist sharp debridement off-loading strategies
as required – frequency negotiated between Nurse/ Podiatrist and this
must be documented in plan of care
The treatment plan should be followed until the prescribing
professional has been consulted and prescription changed.
Changes to foot ulceration:
Urgent / Acute
follow pathway as above
Blackpool Teaching Hospitals NHS Foundation Trust
ID No. ALTC/SOP/017
Title: Shared Care Pathway for Management of Foot
Revision No: 1
Next Review Date: 0611/2023
Ulceration for Patients under the Care of Podiatry
and Community Nursing Services
UNCONTROLLED COPY WHEN PRINTED
Current Version held on the Intranet
Page 8 of 15
5 Training
Al staff involved in wound management on the feet should attend the following educational
training where required. Sessions are advertised through the clinical improvement team
patient safety training booklet and OLM via One HR.
•
Tissue Viability as part of trust induction
•
Doppler and Lower Limb Assessment and procedure for measuring ABPI and TBPI
•
Pressure Ulcer Prevention and Management Workbook
Advanced podiatrists and community nursing link nurses also offer in house training
sessions on request and this can be booked by contacting them direct.
5.1 Monitoring (Including Standards)
Standard
Time frame /
format
How
Whom
Patients with a new wound
Annual
Records audit through
Team leader /
identified below the malleolus
1-1 supervision and
Clinical Lead
to have vascular assessment
peer review
(and ABPI) undertaken within 2
weeks of first assessment and
Documentation on EMIS
repeated as per Doppler policy
Patients identified as showing Annual
Records audit through
Team leader /
signs of deterioration in foot
1-1 supervision
Clinical Lead
ulceration a joint visit /
consultation by podiatrist and
Documentation on EMIS
nurse has been instigated
For patients with foot
Annual
Records audit through
Team leader /
ulceration photographs are
1-1 supervision
Clinical Lead
available to show initial
presentation
Documentation on EMIS
Blackpool Teaching Hospitals NHS Foundation Trust
ID No. ALTC/SOP/017
Title: Shared Care Pathway for Management of Foot
Revision No: 1
Next Review Date: 0611/2023
Ulceration for Patients under the Care of Podiatry
and Community Nursing Services
UNCONTROLLED COPY WHEN PRINTED
Current Version held on the Intranet
Page 9 of 15
6 References and Associated Documents
1.
NHS. NHS Long Term Plan. [Online] 21 08 2019. [Cited: 20 07 2020.]
https://www.longtermplan.nhs.uk/.
2.
BTHFT - Procedure. Photography and Video Recordings of Patients: Confidentiality
and Consent, Storage and Copyright. [Online] 08 03 2017. [Cited: 29 10 2020.]
http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-PROC-002.docx.
CORP/PROC/002.
3. —. Tissue Viability / Pressure Ulcer Risk Assessment, Management / Prevention /
Treatment and Reporting. [Online] 18 04 2019. [Cited: 06 02 2020.]
http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-PROC-642.docx.
CORP/PROC/642.
4.
BTHFT - Leaflets. How to help keep yourself safe. [Online] 04 05 2019. [Cited: 22 01
2020.] http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Information%20Leaflets/PL1005.pdf.
5.
BTHFT - Policy. Management of Incidents, Incorporating Serious Incidents. [Online] 18
10 2019. [Cited: 03 01 2020.]
http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-POL-605.docx.
CORP/POL/605.
6.
British Orthopaedic Association, British Orthopaedic Foot and Ankle Society,
Vascular Society, Diabetes UK, Association of British Clinical Diabetologists, Foot
in Diabetes UK; British Association of Prosthetists and Orthotists. Operational
Delivery of the Multi-Disciplinary Care Pathway for Diabetic Foot Problems. [Online] 04
2016. [Cited: 06 11 2020.] https://www.diabetes.org.uk/professionals/position-statements-
reports/specialist-care-for-children-and-adults-and-complications/operational-delivery-of-
the-multi-disciplinary-care-pathway-for-diabetic-foot-problems.
7.
Department of Health and Social Care. Our health, our care, our say: a new direction
for community services. [Online] Published 30 January 2006. [Cited: 05 05 2020.]
https://www.gov.uk/government/publications/our-health-our-care-our-say-a-new-direction-
for-community-services.
8. —. Policy Paper - 2010 to 2015 government policy: health and social care integration.
[Online] 08 05 2015. [Cited: 06 11 2020.]
https://www.gov.uk/government/publications/2010-to-2015-government-policy-health-and-
social-care-integration/2010-to-2015-government-policy-health-and-social-care-integration.
9.
Crown. Health and Social Care Act 2012. [Online] 2012. [Cited: 06 03 2020.]
http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted.
10.
International Diabetes Federation. IDF Clinical Practice Recommendations on the
Diabetic Foot. [Online] 2017. [Cited: 06 11 2020.] https://www.idf.org/about-diabetes/54-
our-activities/222-idf-clinical-practice-recommendations-on-the-diabetic-foot.html.
11.
National Wound Care Strategy Programme. Lower Limb Recommendations.
[Online] 14 10 2020. [Cited: 06 11 2020.] https://www.ahsnnetwork.com/about-academic-
health-science-networks/national-programmes-priorities/national-wound-care-strategy-
programme/clinical-workstreams/lower-limb-clinical-workstream.
12.
North West Coast Strategic Clinical Network. Diabetes Footcare Blueprint. [Online]
10 2018. [Cited: 06 11 2020.] https://www.england.nhs.uk/north-west/north-west-coast-
Blackpool Teaching Hospitals NHS Foundation Trust
ID No. ALTC/SOP/017
Title: Shared Care Pathway for Management of Foot
Revision No: 1
Next Review Date: 0611/2023
Ulceration for Patients under the Care of Podiatry
and Community Nursing Services
UNCONTROLLED COPY WHEN PRINTED
Current Version held on the Intranet
Page 10 of 15
strategic-clinical-networks/our-networks/diabetes/protocols-and-standards/diabetes-
footcare-blueprint-report-and-key-documents/.
13.
NICE. Diabetic foot problems: prevention and management. [Online] Last updated: 11
October 2019. [Cited: 06 11 2020.] https://www.nice.org.uk/guidance/ng19. NICE guideline
[NG19].
14.
The Col ege of Podiatry. Good Practice in Prescribing and Medicinie Management for
Podiatrists.
3rd Edition. [Online] 09 2018. [Cited: 06 11 2020.] https://cop.org.uk/the-
college/medicines/policy-and-guidance.
15.
BTHFT - Procedure. Conservative Sharp Debridement in Advanced Wound
Management. [Online] 04 05 2018. [Cited: 06 11 2020.]
http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-PROC-711.docx.
CORP/PROC/711.
16. —. Leg Ulcer and Doppler Assessment Procedures. [Online] 29 06 2017. [Cited: 06 11
2020.] http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-PROC-635.docx.
CORP/PROC/635.
17.
BTHFT - Policy. Medicines Policy. [Online] 20 12 2018. [Cited: 17 02 2020.]
http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-POL-300.docx.
CORP/POL/300.
18.
BTHFT - Procedure. Consent to Examination or Treatment. [Online] 06 06 2018.
[Cited: 02 11 2020.] http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-
PROC-102.docx. CORP/PROC/102.
19.
BTHFT - Policy. Infection Prevention (Covid-19 updated). [Online] 10 05 2019. [Cited:
05 10 2020.] http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-POL-
116.docx. CORP/POL/116.
20.
BTHFT - Procedure. Health Record – Generic Clinical Record Keeping Standards
Procedure. [Online] 21 11 2019. [Cited: 22 01 2020.]
http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-PROC-567.docx.
CORP/PROC/567.
Central Lancs diabetes steering group (2009) Central Lancashire diabetes guidelines:
Central Lancashire diabetes steering group.
DH 2012 Health and Social Care Bil .
Management of Black heels- A Multidisciplinary approach (NHSSB) The northern health
and social services board (2005)
NICE. (2008). Quality and Productivity: Supplementary Prescribing In Podiatry.
www.evidence.nhs.uk/qualityandproductivity
North West Podiatry Services PVD Clinical Effectiveness Group. (2020). Guidelines for the
Assessment of Peripheral Vascular Disease. North West Podiatry Services PVD Clinical
Effectiveness Group.
Popadiuk S. (2010), NMP in a MDT Diabetic Foot Clinic – Poster Presentation. Presented
at International Conference on the Diabetic Foot, Uppsalla Sweden 2010.
The society of Chiropodists and Podiatrists (2010) A guide to the benefits of podiatry to
patient care.
Blackpool Teaching Hospitals NHS Foundation Trust
ID No. ALTC/SOP/017
Title: Shared Care Pathway for Management of Foot
Revision No: 1
Next Review Date: 0611/2023
Ulceration for Patients under the Care of Podiatry
and Community Nursing Services
UNCONTROLLED COPY WHEN PRINTED
Current Version held on the Intranet
Page 11 of 15
7 Definitions and Abbreviations
ABPI
Ankle Brachial Pressure Index - A method of assessing the arterial blood
supply to the lower limbs
Abscess
A pus-fil ed cavity resulting from inflammation and usual y caused by
bacterial infection
Acute
A disease/disorder that is brief with sudden onset
Aetiology
The cause of – disease/disorder
Arterial
Involving or contained in the arteries
Aseptic
Free of disease-causing microorganisms
Bacteraemia The presence of bacteria in the blood
Cellulitis
Inflammation of any of the tissues of the body, characterized by fever,
pain, swelling, and redness of the affected area
Chronic
An il ness or medical condition that lasts over a long period and
sometimes causes a long-term change in the body
Colonised
The presence of bacteria on the body surface without causing disease in
the person
Conservative Relieve symptoms or preserve health with minimum simple intervention
Culture and sensitivity
A test to define the type of bacteria and to determine which antibiotics can
successfully fight the infection
Debridement Removal of dead, devitalized, contaminated tissue or foreign matter from a
wound
Doppler
A test that measures the blood pressures in the legs to make sure there is
normal blood flow
Dressing
A therapeutic or protective material applied to a wound
Emollient
An agent that hydrates, softens or soothes the skin
Erythema
Redness of the skin caused by dilatation and congestion of the capil aries,
often a sign of inflammation or infection
Excoriated
Wearing or abrasion of the skin
Foot ulcer
Wound present below the malleolus
Granulation
Small, fleshy, beadlike nodules, consisting of outgrowths of new
capil aries, on the surface of a wound that is healing
Haemorrhage Bleeding from ruptured blood vessels
Holistic
Relating to the consideration of the complete person
Infection
Invasion and multiplication of microorganisms in body tissue
Inflammation Swelling, redness, heat, and pain produced in an area of the body as a
reaction to injury or infection
Macerated
White softened tissue caused by prolonged exposure to moisture
Blackpool Teaching Hospitals NHS Foundation Trust
ID No. ALTC/SOP/017
Title: Shared Care Pathway for Management of Foot
Revision No: 1
Next Review Date: 0611/2023
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and Community Nursing Services
UNCONTROLLED COPY WHEN PRINTED
Current Version held on the Intranet
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Malleolus
The ankle bone
Malnutrition
A lack of healthy foods in the diet, or an excessive intake of unhealthy
foods, leading to physical harm
Malodour
A distinctive odour that is offensively unpleasant
Microbiology The scientific study of microscopic organisms and their effects
Microcirculation
The flow of blood or lymph through the smallest vessels of the body
Necrotic
The death of cells in tissue caused by disease or injury.
Oedema
A build-up of excess serous fluid between tissue cells
Pathogenic organism
Bacteria that produce il ness
Pressure Ulcer A pressure ulcer is localised injury to the skin and/or underlying tissue
usually over a bony prominence, as a result of pressure, or pressure in
combination with shear and/or friction
Purulent
Relating to containing or consisting of pus
Pus
The yellowish or greenish fluid that forms at sites of infection, consisting of
dead white blood cel s, dead tissue, bacteria, and blood serum
Pyrexia
High temperature or fever
Sanguinous
Relating to blood; bloody
Scab
A hard crust of dried blood, serum, or pus that forms over a wound during
healing
Sepsis
The condition or syndrome caused by the presence of microorganisms or
their toxins in the tissue or the bloodstream
Septicaemia Toxic microorganisms in the bloodstream
Serosanguinous
Consisting of clear serum and blood
Slough
Dead tissue, usually cream or yellow in colour present on a wound bed
Strike-through Leakage of wound exudate onto the outside of a dressing/bandage
TBPI
Toe Brachial Pressure Index - A method of assessing the arterial blood
supply to the lower limbs using the toes
UIR
Untoward Incident Report
Ulcer
Wound on the skin that does not heal and results in the destruction of
tissue
Undermining Areas of tissue loss underneath intact skin or a hollow between the skin
surface and a wound bed
Vascular insufficiency
Inadequate peripheral blood flow, caused by disease, obstruction or
blockage
Venous
Relating to or involving the veins
Venous return Blood in the veins, which is returning to the heart
Wound
Injury to the skin, cause by trauma or disease
Blackpool Teaching Hospitals NHS Foundation Trust
ID No. ALTC/SOP/017
Title: Shared Care Pathway for Management of Foot
Revision No: 1
Next Review Date: 0611/2023
Ulceration for Patients under the Care of Podiatry
and Community Nursing Services
UNCONTROLLED COPY WHEN PRINTED
Current Version held on the Intranet
Page 13 of 15
Appendix 1: Equality Impact Assessment Form
Department
Clinical Quality &
Service or Policy
ALTC/SOP/017
Date Completed:
January 2018
Ef ectiveness
GROUPS TO BE CONSIDERED
Deprived communities, homeless, substance misusers, people who have a disability, learning disability, older people, children and families, young
people, Lesbian Gay Bi-sexual or Transgender, minority ethnic communities, Gypsy/Roma/Travellers, women/men, parents, carers, staff, wider
community, offenders.
EQUALITY PROTECTED CHARACTERISTICS TO BE CONSIDERED
Age, gender, disability, race, sexual orientation, gender identity (or reassignment), religion and belief, carers, Human Rights and social economic /
deprivation.
QUESTION
RESPONSE
IMPACT
Issue
Action
Positive
Negative
What is the service, leaflet or policy
To guide the use of conservative sharp
development?
debridement for wound management by
What are its aims, who are the target
the Tissue Viability Team
audience?
Does the service, leaflet or policy/
No
development impact on community safety
•
Crime
•
Community cohesion
Is there any evidence that groups who
No
should benefit do not? i.e. equal
opportunity monitoring of service users
and/or staff. If none/insufficient local or
national data available consider what
information you need.
Does the service, leaflet or development/
No
policy have a negative impact on any
geographical or sub group of the
population?
How does the service, leaflet or policy/
No
development promote equality and
diversity?
Does the service, leaflet or policy/
No
development explicitly include a
commitment to equality and diversity and
meeting needs? How does it demonstrate
its impact?
Does the Organisation or service
No
workforce reflect the local population? Do
we employ people from disadvantaged
groups
Wil the service, leaflet or policy/
No
development
i. Improve economic social conditions
in
deprived areas
ii. Use brown field sites
iii. Improve public spaces including
creation of green spaces?
Does the service, leaflet or policy/
No
development promote equity of lifelong
learning?
Does the service, leaflet or policy/
No
development encourage healthy lifestyles
and reduce risks to health?
Does the service, leaflet or policy/
No
development impact on transport?
What are the implications of this?
Does the service, leaflet or
No
policy/development impact on housing,
housing needs, homelessness, or a
person’s ability to remain at home?
Are there any groups for whom this
No
policy/ service/leaflet would have an
impact? Is it an adverse/negative impact?
Does it or could it (or is the perception
that it could exclude disadvantaged or
marginalised groups?
Blackpool Teaching Hospitals NHS Foundation Trust
ID No. ALTC/SOP/017
Title: Shared Care Pathway for Management of Foot
Revision No: 1
Next Review Date: 0611/2023
Ulceration for Patients under the Care of Podiatry
and Community Nursing Services
UNCONTROLLED COPY WHEN PRINTED
Current Version held on the Intranet
Page 14 of 15
Appendix 1: Equality Impact Assessment Form
Does the policy/development promote
No
access to services and facilities for any
group in particular?
Does the service, leaflet or
No
policy/development impact on the
environment
• During development
• At implementation?
ACTION:
Please identify if you are now required to carry out a Full Equality
Yes
No
(Please delete as
Analysis
appropriate)
Name of Author:
Date Signed:
Signature of Author:
Name of Lead Person:
Date Signed:
Signature of Lead Person:
Name of Manager:
Date Signed:
Signature of Manager
Blackpool Teaching Hospitals NHS Foundation Trust
ID No. ALTC/SOP/017
Title: Shared Care Pathway for Management of Foot
Revision No: 1
Next Review Date: 0611/2023
Ulceration for Patients under the Care of Podiatry
and Community Nursing Services
UNCONTROLLED COPY WHEN PRINTED
Current Version held on the Intranet
Page 15 of 15
Document Outline