Patients with diabetes admitted to hospital are at high risk of foot ulceration, particularly pressure ulcers of the heels. These can be prevented by screening to detect those at risk and the subsequent provision of foot protection. Unfortunately the National Diabetes Inpatient Audits (NADIA) in 2009 and 2010 revealed that 3.2 and 2.2% of inpatients with diabetes respectively developed a new foot lesion whilst in hospital yet only 31.4% and 27.2% respectively had their feet examined.

To increase foot screening in those with diabetes admitted to hospital and to identify those at risk we introduced an innovative tool, the Foot of the Bed form (FoB form) in Ipswich Hospital NHS Trust. The FoB form includes a check list to identify those at risk of ulceration based on previous history, a simple tool to detect those with loss of sensation in the feet, the Ipswich Touch Test (IpTT), and a daily heel check with a referral pathway for those at risk or those who already have a foot lesion. At Ipswich Hospital the FoB form increased foot examination from 27% to 55%, 75%, 80% and 79% at 3, 4, 5 and 10 months respectively and following it inclusion as part of the quality governance plan (CQUIN) for Ipswich Hospital compliance now exceeds 85%. Importantly there has been a reduction in hospital acquired heel ulcers of more than 50%.

As one of the first initiatives following collaboration between the Ipswich Hospital NHS Trust, Sanofi Diabetes and NHS Diabetes we would like to offer the tool to other hospital trusts agreeing to participate in a relatively simple study of the implementation and audit of outcomes over a 24 month period. The audit is important as it will help provide the evidence of the value (or otherwise) of the IpTT but from our experience we believe that repeated audit and acting on the results are key to successful uptake.

If the results obtained at the Ipswich hospital are repeated elsewhere, hospital acquired foot lesion could be halved with a reduction in hospital costs and considerable reduction in morbidity and mortality.

Registering for this project is now closed but if you like further further interest in the project please contact Dr Gerry Rayman - gerry.rayman@ipswichhospital.nhs.uk or Chris Kerry – chris.kerry@ipswichhospital.nhs.uk