This document summarizes a foot care initiative for dialysis patients in Fraser Health Authority. It found that lower limb disease affects 30-40% of dialysis patients and is associated with higher mortality. The initiative aims to establish early detection and treatment of lower limb lesions through a multi-disciplinary approach. A pilot at ARH involves a 'Socks Off Week' with 60-second foot assessments every 6 weeks. Preliminary results show decreased lower limb infection rates, hospitalization days and rates, and mortality rates after the intervention. The initiative aims to expand and perform further analysis and cost-benefit studies.
2. Background
Burden of Lower Limb disease
Lower limb disease
affects 30-40% of
prevalent dialysis
patients
Ndip,A et al. Diabetes Care 2010
3. Background
Lower limb disease associated with significant morbidity
and mortality in dialysis patients
Orimoto et al. J Vasc Surg 2013
5 year survival:
43%
(CORR Data 2010)
5 year survival
with foot lesion:
23%
5. Project Intent
• To establish a multi disciplinary approach to early
detection and treatment of lower limb lesions in
patients with ESRD
6. Project Outline
Pilot at ARH over 2 years duration measuring
outcomes before and after intervention
Outcomes of interest:
1. Rates of limb amputation
2. Days of hospitalization per year
3. All cause mortality
15. Costs
Service Cost (Dec 1, 2013- Nov 30, 2014)
Podiatry:
Partial MSP covered ($23 / visit)
$150/new consult , $79/follow up
$44 080.50
Unit Clerk $1198.40
Nursing Project Coordinator
(with hours for Nurse Champion)
$35 609.96
TOTAL $80 888.76
16. Next Steps
• Pilot continues until Dec 1, 2015 (2 years)
• Final data expected May 2016
• Expansion of intervention to SMH and RCH
• Perform cost benefit analysis
• Coordinate with the BCPRA to create a province
wide strategy
17. Thank You
• Sarah Lacroix (Project Coordinator)
• Dr Scott Schumacher (Podiatrist)
• Welman Lee, Dr Daniel Schwartz,
Ruth Burns, Jan Olsen
• All the Renal Nurses at ARH!!
Notas do Editor
NDIP, A et al. Diabetes care 2010
Long term follow up study on 234 hemodialysis patients in japan (followed up 1980 -2011), 31 year follow up
Shows very poor rates of survival in ESRD patients with a foot lesion
Revascularization did not improve survival but there was biased in selection of patients revascularized
The meta analysis of over 48 000 dialysis patients and these factors listed about were shown to have statiscal significance in this population