Diabetic foot care in a long-term facility

Foot problems continue to be a major cause of morbidity, disability, and mortality for individuals with diabetes. According to Rothman's model of causation, as interpreted by Pecoraro, Reiber, and Burges (1990), each amputation related to diabetes implies the existence of a completed causal pathway of predisposing factors. The purpose of this descriptive retrospective study was to evaluate foot care provided to residents in a 179-bed long-term care facility. The charts of all 17 eligible residents with a diagnosis of diabetes mellitus were reviewed for documentation of assessment and care of their feet. All data were collected by the investigator using the Minimum Data Set (MDS) 2.0 Assessment of Diabetic Foot Care Instrument and a demographic and foot care history instrument. Foot problems were documented for 59% of the participants. Podiatrist-documented foot examination was found in only one of the charts reviewed; however, six residents had been referred to podiatrist. Throughout the charts reviewed, no documentation of protective sensation using the Semmes-Weinstein monofilament or vibration test was found. The findings of this study are consistent with previous research that showed a gap exists between the established standard and the degree to which the standards are met (Fain & Melkus, 1994; Wylie-Rosett et al., 1995). Adequate attention to the problem by health care providers, efforts to increase awareness of foot care standards, and early intervention may be steps to close the gap. Nurses must identify patients at risk for foot problems and actively intervene to prevent complications from occurring.