CLINICAL PROCEDURE FOR PODIATRIC CALLUS AND CORN REDUCTION (Community Podiatrists)

Transcription

1 CLINICAL PROCEDURE FOR PODIATRIC CALLUS AND CORN REDUCTION (Community Podiatrists) Issue History Issue Version Purpose of Issue/Description of Change Planned Review Date 1 To provide Podiatry staff employed by the Trust with fundamental principles relating to callus and corn reduction October 2015 Named Responsible Officer:- Approved by Date Head of Podiatry Quality, Patient Experience and Risk Group Target Audience October 2012 Section:- CP66 Podiatry staff employed by the Trust UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM TRUST WEB SITE THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION

2 CONTROL RECORD Title Clinical Procedure for Podiatric Callus and Corn Reduction (Community Podiatrists) Purpose To promote safe and effective reduction of pathological callus and corns by Community Podiatrists Author Quality and Governance Service (QGS) Equality Assessment Integrated into procedure Yes No Subject Experts Carl Royston (Deputy Head of Podiatry) Document Librarian QGS Groups consulted with :- Clinical Policies and Procedures Group Infection Control Approved October 2012 Date formally approved by October 2012 Quality, Patient Experience and Risk Group Method of distribution Intranet Archived Date 10 th October 2012 Location:- S Drive QGS Access Via QGS VERSION CONTROL RECORD Version Number Author Status Changes / Comments Version 1 Quality and Governance Service R First version Status New / Revised / Trust Change 2/8

3 CLINICAL PROCEDURE FOR PODIATRIC CALLUS AND CORN REDUCTION INTRODUCTION Pathological callus and corns develop when skin is subjected to abnormal stresses caused by intermittent pressure and/or friction. Physiological callus occurs in pre-disposing conditions such as Tylosis. In both cases management is aimed at relieving pain, and reducing the risks of fissuring and ulceration by the reduction of hyperkeratosis. This is achieved in podiatry by sharp debridement, abrasive debridement, chemical ablation and/or pressure redistribution. This procedure will focus upon sharp and abrasive debridement techniques. TARGET GROUP This procedure will only be undertaken by Community Podiatrists and supervised students on placement. TR AINING All staff in the Trust are required to comply with mandatory training as specified in the Trust s Mandatory Training Matrix. Clinical Staff are also required to comply with service specific mandatory training as specified within their service training matrix. EDUCATIONAL REQUIREMENTS Community Podiatrists carrying out callus and corn reduction in line with this procedure will be employed by the Trust and will maintain their HPC registration. Evidence of their ongoing Continuing Professional Development to be shared at their annual performance development review. (PDR). RELATED POLICIES Please refer to relevant Trust policies and procedures INDICATIONS Painful Symptomatic Callus Physiological or Asymptomatic Callus likely to cause secondary pathologies Heloma Durum Heloma Molle Heloma Milliare Verruca Pedis Neurovascular Corns 3/8

4 CLINICAL PRECAUTIONS History of Ulceration The Presence of Localised Infection Micro-vascular changes or compromised circulation Haemorrhagic Conditions or Anti-coagulant therapies Rheumatoid Arthritis Neuropathic Sites Cellulitis CONTRAINDICATIONS Current Ulceration (Refer to Podiatric Procedure for Sharp Debridement) Asymptomatic physiological callus Superficial callus over plantar bursae in patients with Rheumatoid Arthritis CONSENT Valid consent must be given voluntarily by an appropriately informed person prior to any procedure or intervention. No one can give consent on behalf of another adult who is deemed to lack capacity regardless of whether the impairment is temporary or permanent. However such patients can be treated if it is deemed to be within their best interest. This must be recorded within the patient s health records with a clear rationale stated at all times. Refer to Trust Consent Policy for further information and guidance. ASSESSMENT OF THE PATIENT PRIOR TO PODIATRIC CALLUS AND CORN REDUCTION All patients presenting with callus or corns should be holistically assessed by the podiatrist prior to undertaking the procedure. Primary treatment methodology should attempt to identify and remove or reduce causative factors. Consideration should be given to alternative or adjunct treatments which should be outlined to the patient in order that they can make an informed decision prior to callus and corn reduction. Alternative/Adjunct treatments to be considered should include; Footwear advice Prescription Footwear and Footwear Modification Gait Analysis Bio-mechanical Interventions and Orthoses Surgical Referral Casting/Offloading 4/8

5 A thorough history of the site requiring callus or corn reduction should be elicited from the patient and recorded prior to treatment. Any interventions should be appropriate to the presenting problem and any clinical precautions identified should be recorded. The degree of appropriate callus and corn reduction for each individual will require the clinical judgment of the podiatrist based upon the presenting features and the history taken. Caution should be taken when performing callus and corn reduction on previous pressure ulcer sites and patients who are at risk of pressure ulcer development. Please refer to the Trust s Procedure for Pressure Ulcer Management. THE PURPOSE AND EXPECTED OUTCOMES OF CALLUS AND CORN REDUCTION The primary purpose of callus and corn reduction is the reduction of peak pressures to which the tissues and underlying structures are subjected. The expected outcomes are; Pain reduction Increased tissue viability Reduced liability to fissuring and ulceration Increased mobility Falls prevention EQUIPMENT Sterile No.3 Scalpel Handle Sterile Diamond Electro-deposition File Sterile single use Scalpel Blade Single use disposable non-sterile gloves Single use disposable apron Appropriate wound care dressings (if required) Sterile single use disposable scissors Sharps container PROCEDURE PRIOR TO CALLUS OR CORN REDUCTION ACTION Verbally confirm the identity of the patient by asking for their full name and date of birth. If client unable to confirm, check identity with family/carer Introduce yourself as a staff member and any colleagues involved at the contact RATIONALE To avoid mistaken identity To promote mutual respect and put the patient at their ease 5/8

6 Wear identity badge which includes name status and designation Ensure verbal consent for the presence of any other third party is obtained Outline any alternative or adjunct treatments involved in the care plan Explain procedure to patient including risks and benefits and gain valid consent. Document the agreed care plan in the patient record For patients to know who they are seeing and to promote mutual respect Students for example, as the patient has the choice to refuse To ensure the patient understanding and compliance To ensure the patient understands procedure and relevant risks To comply with the current health records policy UNDERTAKING CORN AND CALLUS REDUCTION Decontaminate hands. ACTION Apply single use disposable apron. Prepare an aseptic field and ensure all equipment and resources are in place by fully opening the sealed instrument pack. Apply single use disposable non-sterile gloves Apply skin tension to the periphery of the callused area to be reduced using the lateral edge of the thumb. Starting at the distal edge of the callus, progressively reduce the thickness of the callus using either lateral cutting strokes from a scalpel blade, or the abrasive action of a diamond electro-deposition file. Continue the process working along parallel lines until callus removal is complete. If corn tissue is evident, identify the extent of the nucleus. Using the point of the scalpel blade circumscribe the diameter of the nucleus. With the scalpel blade steeply angled undercut and remove the conical nucleus in it's entirety RATIONALE To reduce the risk of transfer of transient micro-organisms on the healthcare worker s hands. To protect clothing or uniform from contamination and potential transfer of micro-organisms. To prepare a clean, safe operating environment and maintain asepsis and prevent contamination of sterile equipment. To protect hands form contamination with organic matter and transfer of microorganisms To control the depth of the callus reduction and stabilise the underlying structures. To reduce the development of ridges and ensure pressure peaks are minimised. To reduce the risks of iatrogenic haemorrhage. To determined the area to be removed. To minimise damage to surrounding tissues. To remove painful tissue with minimal tissue trauma. 6/8

7 Any iatrogenic haemorrhage which cannot be arrested by digital pressure should be controlled by the application of a haemostatic dressing. Any minor capillary haemorrhages should be arrested and protected by a plastic film dressing or sterile absorbent dressing. Advise the patient of any additional redressing regime which might be required, and ensure they are advised and understand how to access the service should they need further dressings or advice. To control bleeding. To reduce the likelihood of post-operative infection. To ensure an optimum healing environment and patients have clarity regarding who to contact if problems/issues should arise. POST CALLUS AND CORN REDUCTION PROCEDURE On completion of procedure remove and dispose of PPE to comply with Management of Healthcare Waste Policy. Dispose of single use equipment, sharps and debrided tissue as per clinical waste policy. Return re-useable instruments for decontamination in line with department protocols and contractors instructions. Ensure all sharps are removed prior to returning to CSSD Decontaminate hands. Document the outcome of the procedure in the patient s health records. Rebook or discharge the patient according to the current podiatry Health Needs Matrix. RATIONALE To prevent cross infection and environmental contamination. To prevent inoculation injury and cross infection. To enable prompt and effective decontamination of instruments. To reduce the risk of inoculation injuries. To remove any accumulated transient skin flora that may have build up under the gloves. To accurately record the outcome of callus or corn reduction To ensure continued care appropriate to health needs. EQUIPMENT All Podiatry instruments must be decontaminated after each episode of care once the instrument pack has been opened. All instruments are sterilised in compliance with ISO 9001 (2008), ISO (2003) and Medical Devices Directive 93/42 EEC 7/8

8 WERE TO GET ADVICE FROM Community Podiatrists employed by the Trust should contact their Line Manager when advice is required. INCIDENT REPORTING Clinical incidents or near misses must be reported and a Trust Incident Form must be completed using the Trust s incident reporting system. SAFEGUARDING In any situation where staff may consider the patient to be a vulnerable adult, they need to follow the Trust Safeguarding Adult Policy and discuss with their line manager and document outcomes. REFERRALS Any referrals to health professionals, therapists or other specialist services must be followed up and all professional advice or guidance documented in the patients health records. EQUALITY ASSESSMENT During the development of this procedure the Trust has considered the clinical needs of each protected characteristic (age, disability, gender, gender reassignment, pregnancy and maternity, race, religion or belief, sexual orientation). There is no evidence of exclusion of these named groups. If staff become aware of any clinical exclusions that impact on the delivery of care a Trust Incident form would need to be completed using the Trust s incident reporting system and an appropriate action plan put in place. REFERENCES Bowden, P.D & Laxton, P. (1999) A basic guide to scalpel technique. Directorate of Podiatry, Salford University. Bowden, P.D, & Gem, M.A. (2002) Scalpel Technique, Level 1 Clinical Practice. Directorate of Podiatry, Salford University. Society of Chiropodists and Podiatrists, (2010) A guide to the benefits of Podiatry to Patient Care 8/8