Case Study - Podiatry Service

Case Study - Podiatry Service

Iodem were asked to investigate a patient safety incident involving the delayed diagnosis in a vulnerable diabetic patient with an acute foot problem. The local Clinical Commissioning Group (CCG) had been unable to commission a multidisciplinary diabetic foot service in secondary care, despite significant attempts to do so prior to the incident.

The case raised a number of safeguarding issues in respect of the care of a vulnerable adult.

The Patient’s medical records were reviewed, focussing on safeguarding issues and neglect, as the Patient was known to adopt a lifestyle that could potentially have impacted upon the success and effectiveness of the treatments he was receiving.

The Patient was found to have full capacity to make choices and decisions.

Iodem were also able to obtain the views and perspectives of a wide range of stakeholders including the Patient.

The information which was gathered was then subjected to a number of GAP analyses, which identified areas of good practice and areas where the lack of an effective care pathway for diabetic foot problems raised concerns about future vulnerable diabetic adults who might require care. Iodem also provided an analysis of the ways in which the gap could be closed.

The Iodem Team found that there was a delay in providing appropriate care for the Patient, which was preventable. At the time of the investigation, the delays experienced could still have occurred. It was clear that delays had arisen due to a lack of understanding of diabetic foot disease.

In order to improve the service for patients with diabetes, Iodem made a series of recommendations to support the commissioning of a diabetic foot service, which met NICE and Diabetes UK Guidelines. In addition, Iodem recommended a programme of education for “front line” staff, centred around foot disorders occurring as a complication of diabetes, and provided advice upon rolling this out.

Iodem also assisted in the design of an information campaign, explaining both community and secondary care services for diabetic foot disease, from the different perspectives of professionals and prospective patients.

Iodem provided advice and support in implementing the recommendations and establishing the service.

The service has now been successfully commissioned and is working effectively.