podiatry service operational policy · 2016-02-17 · title: podiatry service operational policy...

PODIATRY SERVICE OPERATIONAL POLICY

Document Reference No:

PTHB / POD 003

Version No: 2

Issue Date: November 2015

Review Date: August 2018

Expiry Date: November 2018

Author: Professional Head of Podiatry

Document Owner: Professional Head of Podiatry

Accountable Executive:

Director of Therapies and Health Sciences

Approved By: Clinical Effectiveness Committee

Approval Date: 17 February 2016 (Virtual CEC approval)

Document Type: Operational Policy Clinical

Scope: Podiatry Service Staff Group

Do not print this document. The latest version will be accessible via the intranet. If the review date has passed please contact the Author for advice.

Disclaimer

Bwrdd Iechyd Addysgu Powys yw enw gweithredol Bwrdd Iechyd Lleol Addysgu Powys

Powys teaching Health Board is the operational name of Powys teaching Local Health Board

Title: Podiatry Service Operational Policy Reference No: PTHB / POD 003 Status: Approved

Issue Date: November 2015 of 23 Expiry Date: November 2018

Version Control

Version Summary of Changes/Amendments Issue Date

1 Initial Issue Oct 2008

2 Reviewed – One Wales Taxonomy included Nov 2015



Item No

Contents Page

Engagement & Consultation 4

Impact Assessment 5

1 1. Introduction 6

2 2. Objectives 6

3 3. Definitions 6

4 4. Responsibilities 7

5 Referral Criteria 7

6 Diabetes Service 7

7 Muscular Skeletal Service 8

8 Nail Surgery 9

9 Verrucae Pedis 9

10 General Clinics 9

11 Domiciliary Visits 10

12 Acceptance of Referral 10

13 Telephone Triage 10

14 Initial Appointment 10

15 Discharge Criteria 11

16 Did Not Attend (DNA) 11

17 Can Not Attend (CAN) 11

18 Multi-disciplinary and Interagency Working 11

19 Podiatry Staff 12

20 Continuing Professional Development 12

21 Training Role 13

22 Mandatory Training 14

23 Staff Absences 15

24 Uniform 16

25 Induction of New Podiatry Staff 16

26 Records and Record Keeping 16

27 Health and Care Standards 17

28 Confidentiality 17

29 Consent 17

30 Risk Management 17

31 Health & Safety 17

32 Equipment 18

33 Clinical Incident Reporting (Datix) 18

34 Concerns 18

35 Related podiatric Policies and Documents 18

36 Implementation 18

37 Monitoring Compliance, Audit and Review 19

Appendices

1 One Wales Taxonomy 20

2 Diabetes UK - Putting Feet First Guidelines 23



ENGAGEMENT & CONSULTATION Key Individuals/Groups Involved in Developing this Document

Role / Designation

Head of Podiatry Service

Podiatry Service

Circulated to the following for Consultation

Date Role / Designation

14/12/15 Professional Heads of Therapies

10/11/15 Podiatry Team

Evidence Base

Please list any National Guidelines, Legislation or Standards for Health Services in Wales relating to this subject area?

HCPC Standards of Proficiency – Chiropodists / Podiatry (September 2013)

HCPC Revised Standards of Conduct, Performance and Ethics (April 2015)

College of Podiatry Standards Standards for Health Services:

1.1 Health Promotion, Protection and Improvement 2.9 medical Devices, Equipment and Diagnostic Systems 3.1 Safe and Clinically Effective Care 3.5 Record Keeping 4.2 Patient Information



IMPACT ASSESSMENTS

Equality Impact Assessment Summary

No

im

pa

ct

Ad

ve

rse

Dif

fere

nti

al

Po

sit

ive

Statement

This policy is staff specific for the provision of the Podiatry service across Powys. Welsh language has been considered and the policy will be available in Welsh.

Age X

Disability X

Gender X

Race X

Religion/ Belief X

Sexual Orientation

X

Welsh Language X

Human Rights X

Risk Assessment Summary

Have you identified any risks arising from the implementation of this policy / procedure / written control document? No new or additional risks have been identified.

Have you identified any Information Governance issues arising from the implementation of this policy / procedure / written control document? Staff follow information governance policies:

IGP 004 Data Protection and Confidentiality Policy

IGP 005 Policy and Procedure for the Destruction of Records

IGP 006 Safe Haven and Information Sharing Policy

IGP 007 Health Records Procedures

IGP 008 Records Management Policy

Have you identified any training and / or resource implications as a result of implementing this? Ongoing training implications are addressed within this document.



1 Policy Statement / Introduction The policy of Powys Teaching Health Board (PTHB) Podiatry Service is to provide evidenced based, equitable and efficient Podiatry Services to individuals who have a medical and /or Podiatry need in line with One Wales Taxonomy (appendix1). The service covers all Powys with provision for children and adults. The Service endeavours to meet the recommendations set out in National Service Framework, Diabetes, Older People and Management of Chronic Conditions. The Service follows Diabetes Delivery Plan, One Wales Taxonomy and Standards for Health and Care. Podiatrists work collaboratively with colleagues in health, social services and the voluntary sector to meet the needs of the individual client and are committed to the promotion and maintenance of good communication through support and Intervention. 2 Objective The PTHB Podiatry Service is committed to deliver the best quality, patient focused Podiatry service within available resources, taking into account equity of access and service delivery across Powys, using documentation, techniques and treatments which have their foundation in evidence based practice.

To deliver a fully co-ordinated, accessible, timely and high quality service for the local population who have a medical and /or Podiatric need.

To develop and maintain best practice by accurate assessment of need in line with One Wales Taxonomy and provide provision of evidence based practice.

To monitor the efficiency and effectiveness of the service on a continuous basis so as to be responsive to new opportunities and changing needs of the Service

To work in partnership with other health care professionals, voluntary sector, and social services in providing appropriate and timely services

3 Definitions

Patients For the purpose of this document, “patient” refers to an individual requiring intervention from a Podiatrists irrespective of age, client group or location.

Registered Podiatrist Is someone who has obtained a degree in Podiatric Medicine AND is currently registered with the Health Care Professions Council (HCPC). This registration is renewable bi-annually, and the Podiatrist MUST present a current valid registration document for inspection by their Team Lead / Line Manager in order to work as a registered Podiatrist in Powys THB. A copy of this registration document will be kept in the staff member’s file.

National Institute for Health and Care Excellence (NICE)

Musculoskeletal Service (MSK)

Clinical Musculoskeletal Assessment and Treatment Service (CMATS)



Did Not Attend (DNA) Patients who fail to turn up for two consecutive appointments will be discharged from the service and must reapply if they need further treatment.

Can Not Attend (CNA) If the patient notifies the contact centre they are unable to attend their appointment, another appointment will be arranged.

4 Responsibilities 4.1 Professional Head of Podiatry provides professional leadership and

governance for Powys THB Podiatry Services.

4.2 Podiatrist will be responsible for patients, planning treatments, carrying out these treatment plans or delegating them to unregistered staff in line with their competencies. Junior Podiatrists will have less complex patients allocated to them than Specialist Podiatrist, and will be supported by a specialist Podiatrist. Specialist Podiatrists would also be expected, from time to time, to take on responsibilities for a specific professional or clinical task Powys wide.

4.3 Unregistered Podiatry Staff will be responsible for continuing treatment for patients, in line with their competencies and job description, as delegated to them by a Podiatrist. Unregistered Podiatry staff, known as Podiatry Assistants, have obtained Agored Cymru accredited units for Podiatry to treat patients who have been assessed by a Podiatrist. All these members of staff will have some clerical/administrative duties delegated to them.

4.4 Specialist Podiatrist have been developed in MSK/CMATS and diabetes. Specialist Podiatrists will be expected to work towards an Advanced Practice portfolio.

5 Referral Criteria Podiatry operates an open access and accepts self-referral. Patients with a medical or Podiatric need will be eligible for ongoing treatment. Referrals can be made to Age Cymru Powys for simple nail care once the patient has been assessed. Some referrals will be triaged and advice will be offered over the telephone if the criteria is not met. 6 Diabetes Service

The diabetes service provides intervention for all clients who have diabetes and to those who are deemed to be at risk of developing foot complications due to their condition. The Diabetes Specialist Podiatrist in North Powys has robust links with the MDT in Royal Shrewsbury Hospital and the Hummingbird Centre. Specialist wound clinics are held at four locations within the county offering rapid and emergency access to those with acute and chronic foot problems such as ulceration and compromised vascular status. The Diabetes Specialists work closely with other health professionals such as Diabetes Specialist Nurses, Tissue Viability Specialist Nurses, Vascular Consultants and Diabetes Consultants.



Education sessions are available to both patients and health care professionals. All clients with diabetes are able to access the service and are categorised in line with the Diabetes Delivery Plan “Putting Feet First” and NICE guidance. All clients who are referred as an emergency will be offered an appointments within 24 hours wherever possible. All new referrals are prioritised as routine/ soon /or urgent and the patient is offered an appointment at their nearest clinic. On attending the initial appointment the patient will have a full foot assessment to ascertain circulatory and sensory status and Podiatric need. The patient will be assessed and risk categorised in line with “Putting Feet First” guidelines. A copy of the assessment will then be forwarded to the client’s medical practice. Moderate and above risk patients will be assessed on a regular basis (Putting Feet First) and treated as needed. The Podiatrist will provide both verbal and written advice. The clients will be able to access the service as needed and will be advised on how to access an emergency appointment Clients with a low risk (Putting Feet First) will be discharged. Clients can always reapply for assessment with ant changes to condition. Appendix 2 Diabetes UK Putting Feet First Guidelines.

7 Musculoskeletal Service

The Musculoskeletal Service (MSK) offers assessments and treatment for clients with gait, injury and foot function problems. Referrals are accepted from any age group. The MSK Specialists in the North works with the Clinical Musculoskeletal Assessment and Treatment Service (CMATS) team and works closely with the Orthopaedic Consultants and the Rheumatology Consultants. Gait analysis and further conservative specialist treatments also undertaken. The MSK Specialist in the Mid/South works closely with the Podiatric Surgeon (Advanced Podiatry Assessment Service – APAS team) MSK Podiatrists can prescribe corrective and palliative orthoses; they also work with the Orthotist providing a surgical foot wear service.



They use a gait analysis scanning machine (RS Scan) in South Powys to assess for function and assist with prescription of orthoses. Clinics are held throughout Powys. 8 Nail Surgery

Nail surgery sessions are held in Welshpool Health Centre, Llandrindod Wells, Brecon and Ystradgynlais Hospitals. An open referral system is in place for those patients who have acute, infected or chronic ingrowing or painful toenails. The patient has an assessment appointment with a follow up surgery appointment. The procedure takes between 40-60 minutes, a redressing appointment is arranged locally the next day wherever possible. Patients may be monitored until their condition has resolved. 9 Verrucae Pedis

The departmental policy is not to treat verrucae pedis with the exception if they are causing acute pain. Evidence based advice for self treatment is given. 10 General Clinics

Clinics throughout Powys offer routine podiatry care for those who have a medical or podiatric need as follows:

Clinic Locations

Newtown Hospital

Machynlleth Hospital

Llanidloes Hospital

Knighton Hospital

Llandrindod Wells Hospital

Bronllys Hospital

Brecon Hospital

Ystradgynlais Hospital

Welshpool Medical Centre

Park Street Clinic Newtown

Llanfyllin Medical Centre

Llanfair Caereinon Health Centre

Llansantffraid Surgery

Rhayader Surgery

Glan Irfon Health and Social Care Centre

Presteigne Medical Centre

Crickhowell Health Centre



11 Domiciliary Visits

The service offers home, ward visits, visits to Residential and Nursing Homes, and to those who are house or bed bound. If the patient is able to leave the house for other appointments they will not be eligible for domiciliary visits. An appointment is obtained by telephoning the contact centre who will advise the patient by letter which day the Podiatrist will be visiting, a time is not given. 12 Acceptance of Referrals

There is a self referral system to the service, referrals are also accepted from GP’s, Consultants and other Health Professionals. All referrals will be registered on Powys Teaching Health Boards patient administration system, Myrddin. Referrals will be screened by a Senior Podiatrist and prioritised as urgent (before 2 weeks) soon (before 4 weeks) or routine (before 10 weeks) and allocated to their nearest clinic. Patients will be placed on a waiting list and seen in date order according to the priority rating above. Patients will be informed of their assessment appointment by letter with a request to bring a current list of medication. 13 Telephone Triage

Any referrals that appear not to meet the service criteria will be selected for telephone triage. The patients will be telephoned by a Senior Podiatrist who will obtain further information regarding their health and foot health risk. Following this they will then either be offered an appointment or given advice over the telephone. 14 Initial Appointment

During the initial appointment the Podiatrist will undertake a full assessment of the patient’s reason for attending, medical history, medication, vascular and neurological status. The eligibility for treatment is determined using the One Wales Taxonomy. Those who meet the access criteria will have a treatment plan discussed and agreed with the Podiatrist. They will be able to telephone the contact centre for an appointment as per treatment plan. Should an appointment be required under 4 weeks the Podiatrist will arrange at the appointment. Appendix 1 One Wales Taxonomy



15 Discharge Criteria

Those patients who do not meet the set criteria or have completed there course of treatment will be discharged from the service. Those who are referred back or reapply within 12 months will be telephoned to see if there is any change in there medical or podiatric condition since discharge. Should their status be the same they will not be offered a further appointment. The Service offers an All Wales Accredited training package for Health Care Assistants, Nursing staff, Care Staff in Residential and Nursing Homes and Volunteers for the Age Cymru nail cutting service “Simply Nails “ This package covers a comprehensive days theory and practical assessments, enabling staff to cut nails of clients who do not meet the criteria for Podiatry care. The training also helps staff to give foot health education to clients and recognise the high risk foot. 16 Did Not Attend (DNA)

Patients who fail to turn up for two consecutive appointments will be discharged from the service and must reapply if they need further treatment. New patients who fail to attend for their initial appointment will be discharged and must reapply/ be re referred for treatment. 17 Can Not Attend (CNA)

If the patient notifies the contact centre they are unable to attend their appointment, another appointment will be arranged. 18 Multidisciplinary and Inter-Agency Working

Podiatrists work closely with members of the multidisciplinary teams and also with other Professionals and Agencies. In addition to direct intervention there is collaboration and joint working with:

Spouses and families

Carers

Other Health professionals e.g., Specialist Nurses, Practice and District Nurses, Tissue Viability Nurses, Physiotherapists, Occupational Therapists, and Orthotists.

Podiatry colleagues outside Powys, All Wales meetings.

General Practitioners

Consultants

3rd Sector



19 Podiatry Staff

The service employs four Specialist Podiatrists, seven Generalist Podiatrists and three Podiatry Assistants. The Head of the Podiatry Service is responsible for the management of the service and management of the Orthotic Service which is provided by an independent company. All Podiatrists have job descriptions based on the agenda for change pay banding and Knowledge and Skill Framework. It is the responsibility of the Head of Podiatry to ensure that all staff work within their job description and maintain their competencies. All staff will be reviewed annually using Powys Teaching Health Board’s Personal Development Appraisal Review. It is the responsibility of the Head of Service to ensure Podiatrists have the appropriate competencies to undertake the roles and responsibilities of their post. All Podiatrists must have current registration with the Health and Care Professions Council and be Members of The Society of Chiropodists and Podiatrists. Recently registered Podiatrists will work within their capabilities and with a supervision and mentor schedule. Each Podiatrist will have access to supervision and peer support and will partake in monthly clinical supervision sessions. 20 Continuing Professional Development (CPD)

All Staff are required to maintain and continue their professional development. Podiatrists will undertake a mixture of learning activities relating to their current and future role in line with Standards set out by the Health and Care Professions Council and the Society of Chiropodists and Podiatrists. All Staff will be required to keep a portfolio with accurate and up to date record of their continuing professional development. They are also required to have a Personal Development plan, any training required should be identified within this. All full time staff have an allowance of half a day a month for CPD activities, this can be taken monthly or as a full day over 2 months. Part time Staff would have the same pro rata. The minimum time commitment for CPD should be 30 hours for full time Staff excluding mandatory training. To be read with in conjunction with:

HR 058 Study Leave Policy and Procedure

M&NP 003 Clinical Supervision for Therapies, Health Sciences, Nursing and Clinical Staff Policy and Procedure



20.1 Appraisal and Staff Development PTHB, through its appraisal and personal development programme, actively provides each podiatrist with the opportunity to undertake relevant courses to work towards maintaining and increasing the current levels of professional qualification required in the Podiatry Team. All podiatry staff will have an annual Personal Development Review (PDR) undertaken by their Line Manager.

20.2 Study Leave and Training Days

Although each team member will have an individual training programme, each person will be responsible for making training applications initially via the Head of Podiatry on a PTHB study leave application form. All podiatry staff must have an agreed training plan that meets the needs of the service and their development within their role as defined by their job description and personal development record. On completion of training or learning, experience will be disseminated within the team. New skills and knowledge will be monitored with appropriate supervision.

20.3 Clinical Supervision / Reflection

PTHB and the Podiatry Service recommend and support clinical supervision, in collaboration with practitioners, to empower them in their roles thus allowing a flexible approach to meet the needs of individuals and specialist practitioners. Clinical supervision requires reflection on clinical practice. Reflection itself takes critical incidents, analyses them and draws conclusions which inform future clinical practices.

21 Training Role

Powys is a Teaching Health Board, therefore the Podiatry service is committed to the support of undergraduate Podiatrists and the training of others. The service will participate in the education of Podiatry Students by providing clinical placements and has close links with the Educational Establishments. In house training is used to develop and ensure the skills and knowledge of less experienced staff. Training is given via All Wales Agored Cymru accredited training for Health Care Assistants (HCA’s), Nursing staff, Carers and Third Sector. The service provides a training programme to qualified nurses in GP practices for the awareness and management of diabetic foot complications and diabetic foot screening. The service also provides patient talks as part of the falls programmes, and to other patient groups.



22 Mandatory Training

PTHB has specified mandatory training which is used by the service. Several of these are available on E learning the rest are classroom method.

Fire Safety

Induction

Information Governance

Treat Me Fairly

Health & Safety

Violence and Aggression

Manual Handling Module A - Theory

Improving Quality

Together (IQT)

-

Level 1 Level 1 Level 1 Levels 1 & 2 Module B Level 1 Bronze Level

½ Hour 1 Hour 1 Hour ½ Hour ½ Hour 1 hour 2 Hours

E-LEARNING

E-LEARNING E-LEARNING E-LEARNING E-LEARNING E-

LEARNING E-

LEARNING

Annual

every 2 years

every 2 years every 2 years every 2 years every 2 years

Once

All the courses above are found on the learning@NHSWales web site – which can be accessed from work and home by typing learning.wales.nhs.uk straight into the address area on the Internet home page.

Safeguarding Adults*

*Currently CLASSROOM

/ FACE TO FACE training

– Book via ESR

(improved E-learning in

development)

Level 1 every 2 years

http://www.iqt.wales.nhs.uk/opendoc/209133

http://www.google.co.uk/url?url=http://www.safeandsecuretraining.co.uk/manual_handling.htm&rct=j&frm=1&q=&esrc=s&sa=U&ei=CLqBVMmyEtf3atFo&ved=0CBYQ9QEwAA&usg=AFQjCNG2S9PFNlbyVbzxP2inpjhDoNE6hw



Podiatry staff must also complete the following subjects at the level indicated for their job role.

Practical Moving

and Handling - Patient Handling

Infection Prevention & Control

Safeguarding Children

Resuscitation Adult BLS

Resuscitation Paediatric

BLS Anaphylaxis

Practical Level 2 Level 2 Level 2 Level 2

2 days initially then 1

day update

½ Hour 1 hour 2hrs 2hrs 2hrs

FACE TO FACE

Book via ESR

E-LEARNING

E-LEARNING FACE TO

FACE Book via ESR

FACE TO FACE

Book via ESR

FACE TO FACE

Book via ESR

every 2 years

Annual every 2 years

Annual Annual Annual

Podiatrist

*some

staff Podiatry Assistant

*Staff who are giving injections/medication need to complete anaphylaxis training

ANNUAL

Personal safety/ breakaway

Caldecott data

BIANNUAL

Consent to treatment

23 Staff Absences

When Staff are absent for short periods such as annual leave or sickness there will be no cover for the affected clinics.



For periods of absence above four weeks, sickness, maternity leave, vacant posts or planned absence e.g. Surgery, the service will provide some cover from other areas to see high priority patients as a minimum. In extreme cases if some clinical sites can not be covered the service may need to be centralised to maximise the use of resources 24 Uniform

All PTHB podiatry staff required to wear a recognised uniform of the Podiatry Service when undertaking clinical work in order to contribute to a corporate identity. Uniforms are issued as appropriate for their role.

Personal protective equipment (PPE) is provided for use where appropriate.

All Podiatry staff are required to wear their identification badges whilst on duty. 25 Induction of New Podiatry Staff

The Podiatry Service operates a comprehensive induction programme for all new staff in line with HR 054 Induction of New Employees Policy and Procedure.

25.1 Podiatry Students To be read in conjunction with:

HR 008 Student Placement Policy and Procedure

The Podiatry Service is actively involved in clinical placements of podiatry students from Cardiff and Birmingham University and elective placements on request from other Universities within the UK.

All students are subject to the Induction process with their clinical placement mentor.

26 Records and Record Keeping

Podiatry records are subject to the Standards and audit required by Powys Teaching Health Board and the Society of Chiropodists and Podiatrists. Podiatry records are maintained in line with guidance on storage, archiving and safe transportation of client records provided by Powys Teaching Health Board’s clinical records policy and procedures. Patient records are audited annually.

IGP 005 Policy and Procedure for the Destruction of Records

IGP 007 Health Records Procedures

IGP 008 Records Management Policy



27 Health and Care Standards 2015

The Head of Podiatry with the help and involvement of the Staff will on behalf of the Service contribute to Powys Teaching Health Board’s improvement plan for Health and Care Standards in accordance with the process established with PTHB. 28 Confidentiality

All staff will conform to statutory and local policies regarding the Data Protection Act (1998) and relevant codes of conduct. 29 Consent

The Service will follow PTHB /CP 002 Consent to Treatment Policy and adhere to the appropriate standards and procedures. 30 Risk Management

To be read in conjunction with:

PTHB / CP 001 Risk Management Policy

PTHB / CP 019 Risk Assessment Procedure

PTHB/ IC 001 All Wales Standard Infection Control Precautions 2013

All identifiable risks should be supported with a risk assessment. Risks must be recorded on the Locality risk register. Staff undertaking home visits where a risk to the clinician has been identified may be accompanied by a chaperone if necessary. All staff are responsible for the safe disposal of sharps prior to sending decontaminated instruments to Hospital Sterilisation and Decontamination Unit (HSDU). Any incidents reported in relation to sharps incidents will be fully investigated and necessary disciplinary action will be taken. 31 Health and Safety

PTHB Health and Safety Policies including Lone Worker Policy will be adhered to by the service. Any difficulties, hazards or risks should be reported immediately to a line manager. The Health and safety policy guides all Staff in mandatory health and safety training requirements. In line with recommended standards the Head of Podiatry will undertake the essential health and safety training for line managers. The Service has an appointed Health and Safety Representative for Podiatry. It is the responsibility of the Head of Podiatry to ensure adequate risk assessments are carried out for



all locations where the service is delivered to make sure suitable are in place to ensure the health safety and welfare of all staff and clients. 32 Equipment

All Equipment is subject to a bi-annual inspection by an approved contractor to ensure all equipment is safe to use. Podiatry Service has a ‘best buys’ list to ensure standardisation across Powys on purchasing and use of equipment where possible. Purchase of equipment needs to be approved via Electronic Device Ordering Form (EDOF) 33 Clinical Incident Reporting (Datix)

In accordance with PTHB policy on risk management the service maintains a contemporary clinical risk register. All clinical incidents, near misses and complaints are registered and reported using DATIX. 34 Concerns

Concerns will be handled in line with PTHB Concerns “Putting Things Right – Managing a Concern” process. Further advice is available to staff from the Concerns Team. 35 Related Podiatric Policies and Documents

The following documents are referred to in this Operational Policy and are available on the intranet or from the Head of Podiatry

One Wales Taxonomy

Diabetes Delivery Plan (Putting Feet First)

Nail Surgery Policy

Verrucae Policy

Lone Worker Policy

Patient Advice Literature

Leaflet for Simply Nails Service

36 Implementation This Operational Policy applies to PTHB Podiatry Service as a whole and those who work within it. The Policy must be brought to the attention of Staff by line managers and advised on its implementation The Head of Podiatry is accountable for the delegated implementation, monitoring and updating of this policy, and is responsible for ensuring that all staff are aware and adhere to it.



37 Monitoring Compliance, Audit & Review The Podiatry Service Operational Policy and standards are auditable to ensure that all Podiatrists are meeting all of the standards required of them. Audit will be carried out as outlined in the 3 year Podiatry Audit Plan. The results will then be presented to the Podiatry Professional Forum Group, who will take forward any action points raised. The Professional Head of Podiatry will share any findings with the Director of Therapies, Health Sciences and the Locality Therapy Leads. This Operational Policy will be reviewed by the Podiatry Professional Forum Group every three years or sooner if professional standards alter within its life span.

Appendix 1

PODIATRY PATIENT SAFETY RISK MATRIX

1

HIGH MEDICAL RISK 2

MEDIUM MEDICAL RISK 3

LOW MEDICAL RISK 4

NO MEDICAL RISK

A VERY HIGH PODIATRY CLINICAL NEED

A1 A2 A3 A4

B HIGH PODIATRY CLINICAL NEED

B1 B2 B3 B4

C MEDIUM PODIATRY CLINICAL NEED

C1 C2 C3 C4

D LOW PODIATRY CLINICAL NEED

D1 D2 Not Eligible

Exception DBM pts where appropriate

D3 Not Eligible

D4 Not Eligible

E LOW FOOT CARE CLINICAL NEED

E1 E2 Not Eligible


E3 Not Eligible

E4 Not Eligible

F NAIL CARE NEEDED F1 Not Eligible


F2 Not Eligible

F3 Not Eligible

F4 Not Eligible

G NO PODIATRY/FOOT CARE CLINICAL NEED

G1 Not Eligible


G2 Not Eligible

G3 Not Eligible

G4 Not Eligible Slide 20



Podiatry NEED Classification

*To be used only in conjunction with One Wales Clinical Risk Taxonomy

These guidelines do not cover all presentations. Podiatrist must use professional judgement when deciding taxonomy EXCEPTIONS MUST BE “Exception Reported” Podiatry All Wales Version 5 June 2015

CLINICAL NEED

These definitions are guidelines and do not cover all foot conditions and care/treatment plan will be determined on an individual basis.

A ACTIVE PODIATRY CLINICAL NEED

Compromised tissue viability and may be limb threatening. Compromises mobility for day to day living and prevents exercise to maintain health and well being

Wounds Texas classified as A-D 1-3 which require wound care intervention.

Sepsis e.g. Onychocryptosis

Acute Cellulitis

Acute Charcot

B HIGH PODIATRY CLINICAL NEED

Compromised tissue viability and mobility for day to day living and prevents exercise to maintain health and well being

Severe Musculoskeletal Pathology both chronic and acute which requires musculoskeletal specialist

intervention and or casted orthotics e.g. post orthopaedic / vascular surgery, achilles tendonitis, plantar heel pain syndrome, ankle sprain, stress fractures, severe foot deformities.

Nail Pathologies which require specialist nail surgery intervention e.g. involution and onychogryphosis

Multiple Foot Lesions & Pathologies which requires frequent / continuous general podiatry care e.g. Heloma

Durum (H.D.) Heloma Molle (H.M.), Heloma Neurovascular

Identification and management of deterioration in foot health where there is both: 1.compromised vascular

status, neurological status, tissue viability, history of previous amputation ( non traumatic) and/or has a history of previous wound Texas classified as C – D O and 2. individual or carer is not currently empowered to maintain and

identify deterioration in foot health.

C MODERATE PODIATRY CLINICAL NEED

May compromise tissue viability and compromises mobility for day to day living and prevents exercise to maintain health and well being

Moderate Musculoskeletal Pathology which require non cast orthotic e.g. moderate foot deformities, mortons

neuroma, plantar fasiitis

Moderate Foot Lesions which require frequent / continuous general podiatry care and not

resolvable/manageable through self/carer intervention e.g. H.D. H.M., callous, Verrucae.

Nail Pathologies that require nail surgery but cannot be operated on or phenolised

D LOW PODIATRY CLINICAL NEED

May comprise health and well being

Minor Foot Lesions & Pathologies resolvable/manageable through self/carer intervention and an individual or

carer is not currently empowered to maintain.. e.g. H.D., H.M. callous, Verrucae

E LOW FOOT CARE CLINICAL NEED


Nail Pathologies where the individual is currently unable to manage and has no carer to help e.g. multiple or

single onychogryphosis, onychomycosis, onychauxis

Non pathological callous where the individual is not currently able to manage and has no carer to help e.g. heels

F NON PATHOLOGICAL NAIL CARE NEED


Normal Nails where individual or carer is not currently empowered to maintain

G NO FURTHER PODIATRY/FOOT CARE CLINICAL NEED (DISCHARGED)

No further Podiatry intervention possible (refer on) e.g. acute trauma –ruptured TA,

No further Podiatry intervention necessary concern resolved

Minor Musculoskeletal Pathology which require education and advice only e.g. curly toes, non symptomatic

HAV

Minor Foot Lesions & Pathologies resolvable/manageable through self/carer intervention. e.g. H.D., H.M.

callous, Verrucae

Education, empowerment and advice provided e.g. diabetic foot care education, normal growth and

development advice

Podiatry Medical Risk Classification *To be used only in conjunction with One Wales NEED Taxonomy



These guidelines do not cover all presentations. Podiatrist must use professional judgement when deciding taxonomy EXCEPTIONS MUST BE “Exception Reported”

1 HIGH MEDICAL RISK

2 MEDIUM MEDICAL RISK

3 LOW MEDICAL RISK

4 NONE

DIABETES (per.

Putting Feet First) Active/ High Podiatric Medical Risk Moderate (increased) Low Risk Good

General Health

CIRCULATORY DISORDERS

Compromised tissue viability

Arteriosclerosis, Macro vascular disease, Vasculitis causing ischemia, Rest pain, intermittent claudication.

Vasospastic Diseases e.g. Raynauds disease, micro vascular disease

Venous Diseases e.g. chronic venous insufficiency

Lymphatic Disease – primary / secondary lymphodema

May compromise tissue viability

Vasospastic Diseases e.g. Raynauds disease, Acrocyanosis, uncontrolled hypertension

Venous Disease predisposition to cellulitis, history of DVT requiring anticoagulant therapy; symptomatic varicosities

History of pulmonary embolism requiring anticoagulant therapy

Controlled hypertension,

Venous Disease asymptomatic varicose veins.

HEART DISEASE Compromised tissue viability Affecting ability to care for feet.

Atrial fibrillation, prosthetic heart valve, unstable angina, myocardial infarction requiring anticoagulant or antiplatlet therapy

Controlled Angina

RENAL DISEASE Stage 4 and 5 Stage 3

BLOOD DISORDERS Affecting immunity AIDS, HIV e.g. poorly controlled Haemophilia, Hepatitis A, B, C, Pernicious anaemia

e.g. Controlled Haemophilia

NEUROLOGICAL DISORDERS


Cerebral vascular Accident (CVA)

Demyelinating Diseases – Multiple Sclerosis(MS)

Degenerative Diseases – Parkinson’s Disease, Motor Neuron Disease

Myopathies

Affecting ability to care for feet.

CVA

Demyelinating diseases MS

Degenerative diseases – Parkinson’s Disease, Motor Neuron Disease

Myopathies.

RESPIRATORY DISORDERS


Chronic Obstructive Pulmonary Disease, Emphysema, Asthma

Mild Asthma

INFLAMMATORY JOINT DISEASE


Rheumatoid Arthritis(Rh.A), Seronegative Arthropathies, Connective Tissue Disease, Arthropathies, Vasculitides


Rh.A, Seronegative Arthropathies, Connective Tissue Disease, Arthropathies, Vasculitides

DEGENERATIVE JOINT DISEASE


e.g. Severe Osteoarthritis (OA), Osteoporosis e.g. OA, Joint replacement

MENTAL HEALTH Compromised ability to care for feet.

Cognitive impairments affecting capacity, understanding, engagement and/or concordance. e.g. Behavioural disorders, dementia, drug dependancy.

.

Other Terminal Conditions (EOL) Presentations which affect tissue viability i.e.; autoimmune disorders

Presentations which affect ability to care for own feet. E.g. Impaired sight



Appendix 2

Putting Feet First Guidelines are available on the Diabetes UK website www.diabetes.org.uk/putting-feet-first

POD 003 Appendix

2 - Diabetes UK Putting Feet First.pdf

http://www.diabetes.org.uk/putting-feet-first