Employing interdisciplinary team working to improve patient ... - EWMA

Science, Practice and Education
An interdisciplinary Diabetic Foot Team in action: Order in the Chaos. Diabetic Foot Clinic – Kristien Van Acker
Standards of Quality for Specialized Diabetic Foot Clinics
according to the Criteria of the Diabetic Foot Working
Group of the German Diabetes Association (DDG) are
based on Structural quality (equipment, documentation,
and staff); Structural- and Process quality (interdisciplinary
cooperation by contract); Process quality (clinical
pathways/standard operation procedures (SOP); Hygiene
plans, (MRSA management plan); Audit (active and passive);
and Quality of performance (treatment results of 30
consecutive patients).
In Belgium, some opinion leaders together with Scientific
Institute of Public Health, Epidemiology in Brussels
developed an “Initiative for Quality of Care Promotion
and Epidemiology in Belgian Diabetic foot clinics”, the socalled
IQED centres. This prospective study is designed to
describe, evaluate and improve the Quality of Care in the
Belgian diabetic foot clinics (DFC) by collecting data and
providing benchmarking. In this study Off-loading was
used in 75% (variation from 42% to 100%) of the ulcer
patients, but a total contact cast was only used in 2.4%.
Of the patients with peripheral arterial disease, 42.8% underwent
revascularization and 59.4% were hospitalized 19 .
34
6. GENERAL CONCLUSIONS AND THE
CONCEPT OF INTERDISCIPLINARY TEAMS
FOR INTEGRATED WOUND CARE
In many countries and societies care facilities have come
a long way in developing their wound care programs,
especially where there is more effort towards an interdisciplinary
approach. They have moved away from the
approach of just having a single wound treatment nurse
and established a more integrated care approach. The most
successful teams are those that have a wound care team
involving all key departments within the facility. In hospitals
it starts with the medical director who facilitates
the necessary patient medical work-ups as, for example, a
therapy to apply specific services such as modalities and
wound debridement, and dietary services to ensure that
those with wounds have adequate nutritional intake. On
the other hand, well skilled home nurses who provide
primary patient care including wound dressings are also
important key players. But in this advanced situation the
key pitfall will be a good referral system and communication
between the first, second and tertiary line teams.
Ultimately, highly coordinated treatment plans are effective
in reducing average wound healing times, thereby
lessening patient suffering and costs of care.
EWMA JOURNAL 2012 VOL 12 NO 2