COVID-19 and iatrogenic harm

It is important that the large number of sick and vulnerable patients with COVID-19 in our Hospitals do not develop iatrogenic harm. High dependency units and all wards need to remember to protect vulnerable groups of patients from more than the impact of the virus - the issue of iatrogenic harm is of serious concern because it amplifies the impact on the individual and NHS resources. If vulnerable patients develop any form of iatrogenic harm it will not only put them at greater risk but will probably delay discharge and use extra NHS resources that at this time are more precious than ever.

The “CPR foot care initiative” (Check - Protect - Refer) was developed, and adopted nationally in Scotland by the Foot Action Group to reduce/prevent iatrogenic harm for vulnerable patients. Initially developed with diabetes in mind and then more recently extended to all vulnerable patients.

We discussed the CPR intitiative in an earlier article.

Even without the challenge presented by the COVID-19 virus we know that some 135 people per week in the UK have a limb amputated as a result of diabetes.

FDUK have released v 1.2 of their COVID 19 Amputation Prevention Guidance. Designed for supporting assessments and decision-making with all people who have high risk lower limbs, with or without diabetes, with a focus on limb threatening infection or ischaemia.

The CPR initiative identified nationally approved pressure redistribution/relieving products. Products which have been approved on the basis of quality, being fit for purpose and of course, value for money.

FDUK have also recently published “Lower Limb Amputation Prevention Guidance”

The essence of CPR

Check

When any at risk patient is admitted to hospital both feet should be checked;

• Remove any current foot dressings

• Does the patient have an existing foot ulcer a foot ulcer, or gangrene?

• Ask the patient if they have had a previous foot ulcer

• Does the patient have neuropathy?

• Is the patient bed bound or have fragile skin?

• Pay special attention to the heel area

• A daily check should be carried out

Protect

If a patient has an existing ulcer or is at risk of developing an avoidable ulcer then care should be taken to protect the patient’s feet, especially if they are confined to bed.

(A pressure relieving mattress does not provide sufficient protection to prevent all at risk patients from developing an avoidable foot ulcer or provide sufficient pressure relief for those with an existing foot ulcer/ulcers.)

The 652SKG offers complete protection of the vulnerable heel area whilst allowing safe ambulation when indicated.

There are various pressure relieving devices available to reduce the pressure on the feet of patients who are at risk of developing an avoidable ulcer and to relieve the pressure on areas of existing ulceration.

The decision of which devices to use will be dependent on whether the patient is ambulant or non ambulant and will be decided by the Nurse for at risk patients or by the Orthotist, Podiatrist or Tissue Viability nurse for patients with active foot disease following assessment of the patient and their specific needs to ensure the correct device is utilised.

Patients and devices can be split into two distinct groups:

• Non ambulatory - devices for use in bed only

• Ambulatory - devices for use in bed and ambulation

The PRAFO range are identified as particularly suitable for the ambulant patient although they are equally at home with the non-ambulatory patient offering complete pressure and shear relief at the heel.

652SKG APU PRAFO

Refer

Patients who have been discovered on admission to have existing pressure damage, an ulcer or gangrene should be protected and then referred immediately to the Podiatrist, TVN or member of the diabetes team

The Podiatrist, TVN or member of the diabetes team will carry out an assessment of the patient’s needs and will advise accordingly

Referral by telephone during normal working hours is generally the quickest and most efficient method but this may depend on the local protocols in place. Please follow usual local referral guidelines/protocols

See https://www.diabetesinscotland.org.uk/resources/
You can find the full PRAFO range here.