Diabetic foot protocol (circle,
tick, cross, or record)
General principles
- If severe, take swabs and 2 sets
of blood cultures, page ID registrar (#323)
- If not severe, avoid antibiotics
prior to surgery
- Don’t wait for histology before
deciding on discharge
- Readmit under vascular unit if
fails on TACT
- Print this form to use as
checklist in file (add sticker; tick-off as you go)
Vascular JMO
- Document clinical assessement
- Presence, size ____ (mm) and depth
____ (mm) of ulcer(s)
- Features of simple infection
(Purulence; Erythema; Pain; Tenderness; Warmth; Induration)
- Features of advanced
infection (Cellulitis > 2cm; Lymphangitis; Deep tissue involvement;
Abscess; Gangrene; Systemically unwell)
- Arterial and Venous status
(including results of studies)
- Neuropathic status (including
pin prick level)
- Document routine investigations
- FBE (WCC ____), U/E+Creat
____ (umol/L), CRP ____ (mg/L), HBA1C ____ (%), Xray
- Swabs of ulcers
- Routine referrals
- ID JMO (#158) or BPT (#191)
- Diabetes CNC (#244)
- Written referral for ID
consultant
- Including: Relevant
investigation results and clinical assessment (as above); Surgical
plan
- If 2 or more features of advanced
infection present (see above)
- Blood cultures (2 sets) and
MRI
- Referral to endocrine
registrar (#363 or #177)
- Referral to PICC nurse (for day 1
post-op) if obvious and/or advised by ID
- Referral to TACT as advised by ID
- Discharge planning not complete
until:
- Patient has been seen post-op
by vascular surgery registrar / consultant
- Outpatient wound management
planned
- Surgical review booked
- Discharge summary includes
all co-morbidities and complications no matter how minor (e.g.,
hypokalemia, hypoglycaemia)
Vascular registrar (operative
management)
- Send deep soft tissue for culture
and histology
- If bone definitely (or possibly)
involved
- Send bone from affected area
and proximal margin (using new and separate scalpels / bone
cutters) for culture and histology
- SEND SPECIMENS FRESH IN SEPARATE
JARS; NOT IN FORMALIN
- Label origin and type very
clearly (e.g., left 3rd metatarsal bone)
- Document condition of remaining
bone / tissue in op notes
- Including LIKELIHOOD and
EXTENT of persistent osteomyelitis
Infectious diseases JMO (or BPT if
unavailable)
- Assist vascular JMO in ticking
off all their boxes
- Document clinical assessment
- Likelihood of osteomyelitis
based on probe to bone test and investigations (as above)
- Suitability and patient
agreement for TACT
- If unclear, ask TACT
nurse to review on ward
- Discuss and review with ID
registrar then consultant
- Co-ordinate antibiotic plan
(inpatient/outpatient; IV/oral; duration)
- Facilitate early discharge to
TACT if meets following criteria: First presentation; No prolonged prior
antibiotics; No MRSA, MRGN, VRE
- Otherwise, choose TACT
antibiotics based on tissue cultures
- NB: TWH pharmacy can
often make first 1-2 days antibiotics
- Liaise directly with TACT to
ensure they’re clear about plan
- Book for BPT / JMO clinic within
2 weeks through IMACS (ext. 5898)
Consensus protocol for Huber /
Villalba patients managed in collaboration with Infectious Diseases unit