Foot Checks: Routine Practice in Special Programs for Incident Dialysis End Stage Renal Disease Patients (SPIDER) with Diabetes.

Background: ESRD patients with diabetes are clearly at higher risk for foot problems. Studies show that peripheral vascular disease (PVD) and peripheral neuropathy (PN) are much more common in diabetes patients on dialysis than in patients without renal insufficiency. Since PVD and PN contribute to the development of foot problems, diabetes patients on dialysis are at an even-greater risk of developing non-healing foot ulcers leading to amputation and increased morbidity and mortality. To prevent these foot problems, daily foot care and inspection is recommended for all people with diabetes. However, compliance with home foot checks and obtaining therapeutic shoes is often low. Approach: To reduce foot complications, we implemented within the SPIDER program in-center interventions of routine foot checks, patient education and referrals for therapeutic shoes. Case Managers were trained to perform foot exams per a corporate policy/procedure, slide presentation, instructor demonstration and participant return demonstration. The comprehensive foot exam included skin assessment, checking pedal pulses, and sensory testing. Patient handouts were specifically designed for teaching daily foot inspection, lubrication, and safety. Electronic documentation and reporting systems were set up to track foot check completion and actions for follow-up. As a result, on average, 85% or more of foot checks were completed monthly in the dialysis clinics as compared to only sporadic or no foot checks being done. Foot problems were identified promptly and patients were referred to appropriate specialists. Patients that qualified for therapeutic shoes were evaluated and fit when applicable. Implications: The patient/staff awareness and satisfaction in finding foot problems through an efficient and manageable process has been significant. Increasing attention to the diabetic foot can benefit in the areas of prevention, early identification of problems, and prompt referrals that can ultimately prevent amputations and subsequently decrease mortality in this high-risk ESRD population. [ABSTRACT FROM AUTHOR]