Noticeboard: Vol 12 No 2

Education tariffs
Q Has anyone agreed a local tariff for group education sessions? We have just started a 4-week intensive education course for people with type 1 diabetes which we need to include into the Payment by Results (PbR) system. Can anyone help?
Maureen Wallymahmed, Nurse Consultant – Diabetes, Liverpool

A We agreed a tariff with our PCT (for ASPIRE, see Journal of Diabetes Nursing 12(1): 6–13) at the end of last year. The package involves a pre-assessment, the insulin skills course (4 days over 4 weeks) and three post-course assessments at 3, 6 and 12 months. The cost for 2008/9 is £4365. If you require further information please feel free to contact me. 
Dee Clark, Nurse Consultant – Diabetes, Chesterfield

Pathways for non-healing ulcers 
Q We are developing a pathway for non-healing diabetic foot ulcers and I would like to know if anyone has developed a protocol for antibiotic treatment. There appears to be some inconsistency about when to start antibiotics and the duration of treatment. I would be grateful for any information.
Name and address witheld

A There are really two questions here – why may foot ulcers not heal, and what are the most appropriate antibiotics for infected foot ulcers? There are many reasons for delayed healing of foot ulcers. Infection – especially bone infection – may be one, but inadequate off-loading is probably the most common. Others may include ischaemia, inappropriate footwear, poor glycaemic control and smoking.

There is no hard evidence base or national policy for antibiotic advice. However, most experts in the field would initially use something like co-amoxiclav or amoxicillin/flucloxacillin (erythromycin if penicillin-allergic). With associated bone infection, clindamycin-based regimens are usually used. 

This is just a brief guide and assessment of the individual, the foot and the wound is essential. A good source of further information is FDUK (foot in diabetes UK: see http://www.footindiabetes.org). 
Rachel Rowlands, Podiatrist, Liverpool, Professor Geoff Gill, Consultant Physician, Liverpool

Telephone care
Q With more diabetes management being carried out in primary care, we have noticed an increase in phone calls for advice and guidance from people with diabetes and primary care staff. While this is a good use of resources, we are aware that it is not being ‘charged for’. Has anyone got a system to deal with this?
Sue Hamilton, DSN, London

Pregnancy and diabetes
Q In women with diabetes, how do people approach preconception care? Additionally, what strategies have other c
linics developed for ensuring women who are pregnant and frequently do not attend appointments receive suitable care
Tina Ali, DSN Aintree University Hospitals NHS Foundation Trust