Wat te doen met het diabetes guidance document anno 2015 in de praktijk? : Samen Sterk & Samen SNEL. Dr. Kristien Van Acker, diabetoloog Chimay, Voorzitter IWGDF & IDF Consultative Section on the Diabetic Foot.
Inhoud lezing 1. Objectief lezing 2. IWGDF- IDF 3. IWGDF-guidance document 4. Kunst van implementeren 5. Efficiënt verwijzen in optimale verwijzingstijd 6. Take home messages ; key-messages
1.Objectief van lezing Kennis :diabetes voet Pre-ulcus/ ulcus/ post ulcus fase Overdracht van deze kennis? Implementatie: gaat verder dan enkel kennisoverdracht Inzicht in medische organisatie Trilogie: welke partners? Wondbehandelaar- patiënt- specialist-
2. IWGDF-IDF? International Working Group on the Diabetic Foot 1996 IDF Consultative Section on the Diabetic Foot 2000
Objectives of IWGDF The aim of the IWGDF is to create awareness of the disease and to improve the management and prevention of the diabetic foot.
Activities of IWGDF www.iwgdf.org Networking and public relations www.iwgdf.org 10.600 sessions/ 7000users 4,5 min /session 6
Representatives 7
Activities of IWGDF Implementation programs from Step By Step to TtFT courses Diabetic Foot Care assistant programs
Dr. Z. G. Abbas
Dr. Z. G. Abbas
Melbourne IDF conference 2013 Change of Chair IWGDF from Karel Bakker to Kristien
Development of an evidence-based global consensus The 2015 IWGDF Guidance documents K. Bakker; J. Apelqvist; B. A. Lipsky; J. J. van Netten; N. C. Schaper
Guidance - Menu
Guidance Detailed Menu
Prevention
Wound Healing
Guidance 2015
4.Kunst van implementeren
Understanding the pre-perand post- ulcer phase Pre ulcer Ulcer Post-ulcer Ulcer 28/11/2011 19
Understanding the pre-per- and post- ulcer phase Pre ulcer Ulcer Post-ulcer Amputation 28/11/2011 20
Understanding the pre-per- and postulcer phase New Ulcer Pre ulcer Ulcer Post-ulcer RELAPS 28/11/2011 21
Intervention programs/implementation guidelines on different levels Hospital Patient & lesions Healing Diabetic Foot Clinic 22
RISICO VOETEN
EDUCATION!!
Intervention programs/implementation guidelines on different levels Hospital Patient & lesions Healing Diabetic Foot Clinic 25
Improved survival of the diabetic foot: the role of a specialized foot clinic Edmonds et al. Q J Med 1986
How to establish a diabetic foot clinic? Diabetologist Nurse Patient Max Spraul, Noordwijkerhout, 1991
How to establish a diabetic foot clinic? Diabetologist Nurse Angiologist Vascular surgeon Patient Podiatrist General surgeon Orthopaedic surgeon X-ray specialist Communication! Microbiologist Max Spraul, Noordwijkerhout, 1991
Karel Bakker slide
Interdisciplinary team: Integrate separate discipline approaches into a single consultation.
Interdisciplinary team: Integrate separate discipline approaches into a single consultation. That is, the patient-history taking, the team, together with the patient, conducts assessment, diagnosis, intervention and short- and long-term management goals at the one time.
Intervention programs/implementation guidelines on different levels Hospital Patient & lesions Healing Primary Care Diabetic Foot Clinic 32
Integrated care Community Nurses Foot Protection Team Multidisciplinary foot care team In-patient service Skills Knowledge Respect Co-operation Communication Awareness GP practices Neil Baker slide
Efficiënt verwijzen in optimale verwijzingstijd
Intervention programs/implementation guidelines on different levels Hospital Patient & lesions Healing Primary Care Diabetic Foot Clinic DELAY in referral=biggest enemy 35
Association between ulcer duration at referral and time to healing (n = 772) Begin of lesion Percentage of ulcers Duration of healing (days) Same month 49% 73 Month before 30% 93 > 1 months before 12% 98 > 2 months before 9% 126 Treece et al., 2003
Oplossingen?
HOE AFSPRAKEN MAKEN IN CORRCETE DOORVERWIJZING? 38
A diabetic foot clinic dynamic referral and back referral Pre ulcer phase Ulcer phase Remission phase Patient follow up Primary Care: nurses, GP s, podiatry Communication!
We support each other
TAKE HOME MESSAGES Kennis delen: guidance document Professionele barriers overstijgen Uw partners kennen en afspraken maken Empowerment van de patiënt Last but not least: voorkomen is beter dan genezen
Conclusie: Alle hens aan dek en we hebben geen tijd meer te verliezen en dit schreven we reeds aan de hand van de wereld diabetes dag in 2005: TIME TO ACT.
NOW WE HAVE TO CATCH THE FISH 43
we can. 44
Thank you on behalf of our patients..