Foot disease is a potentially devastating complication of diabetes and, as a consequence, a lower limb is lost every 30 seconds somewhere in the world (Boulton et al, 2005). In the UK, diabetic foot complications are the largest single reason that people with diabetes are admitted to hospital (Boulton et al, 2005) and the costs associated are a substantial economic burden (estimated to be £239 million per annum for; Gordois et al, 2003). The indirect costs to the person with diabetic foot disease and their family – both in economic and quality-of-life terms – are also high (Brod, 1998).
It is widely agreed that foot screening and risk stratification are cornerstones of good diabetic foot care (NICE, 2004; SIGN, 2010; British Medical Association and NHS Employers, 2011) that can effectively identify people who ulcerate (Leese et al, 2011). Furthermore, it has been demonstrated that foot screening can be carried out effectively by any suitably trained healthcare professional (Leese et al, 2006). Although the Scottish Diabetes Group’s Foot Action Group has produced a large amount of information on how to carry out foot screening, there has been a need for an accredited, formalised and easily accessible training programme that allows any healthcare professional involved in the care of the person with diabetes to gain the competencies required to undertake this specific, valuable task.
With the aid of a grant from the Scottish Government, the Scottish Diabetes Group’s Foot Action Group has produced an online diabetic foot screening training programme called FRAME (www.diabetesframe.org), which was launched at the 12th Annual Diabetic Foot Conference in Edinburgh (conference proceedings report on page 138). The Foot Action Group called on the expertise of the Department of E-learning, University of Edinburgh, to assist them in this project, and the site is the culmination of a year’s work by this team.
The FRAME website hosts four sections: (i) an overview of diabetes, (ii) an overview of diabetic foot problems, (iii) the purpose of foot screening, (iv) the procedure. These modules culminate in a series of case scenarios, which, if completed correctly, generate a continuing professional development certificate.
The practical modules focus on carrying out the screening, and on the entry of the screening outcomes into the Scottish Care Information Diabetes Collaboration (SCI-DC) system. SCI-DC is the national clinical information system for the management of diabetes across NHS Scotland (Stang et al, 2010). When all the appropriate screening information has been entered, SCI-DC automatically calculates the patient’s risk status in accordance with the Quality and Outcomes Framework (QOF; British Medical Association and NHS Employers, 2011) guidelines and sends the required information to the GP database to ensure related QOF indicators are met.
The Diabetes Action Plan 2010: Quality Care For Diabetes In Scotland (Scottish Government, 2010) – in line with Healthcare Improvement Scotland – has a target where, by April 2012, 80% of people with diabetes should have an allocated foot-risk score, which is communicated clearly to the patient and electronically communicated to all healthcare professionals involved in the care of the patient. In 2007, this figure was 25%. With the work that the Foot Action Group carried out, the figure rose to 51%
by the end of 2010, with 61% having ever had a score. With FRAME now live, it is hoped that the April 2012 target of 80% will be achieved.
Already the website is proving to be a success, having received 1722 visits and 27000 page views since its launch. It is hoped that FRAME will ensure quality and consistency in the delivery of foot screening throughout NHS Scotland by giving healthcare professionals the appropriate skills and knowledge to carry out this important task. Discussions are currently underway as to how the FRAME site might be extended to meet local healthcare providers’ needs outside of Scotland and the UK, and The Diabetic Foot Journal will keep you updated on FRAME’s progress and any future roll-outs.