Module quiz (N.B. all fields are compulsory)Name* Dr.MissMr.Mrs.Ms.Prof.Rev. Title First name Last name Email* NHS Board*Ayrshire and ArranBordersDumfries and GallowayFifeForth ValleyGolden Jubilee National HospitalGrampianGreater Glasgow and ClydeHighlandLanarkshireLothianOrkneyShetlandTaysideWestern IslesNHS EnglandNHS Northern IrelandNHS WalesNot applicableYour place of work (i.e. GP practice or hospital)* Your profession*ConsultantDistrict NurseDoctorHealth Care AssistantHealth Care WorkerOrthotistParamedicPhysiotherapistPodiatristPodiatry AssistantPodiatry TechnicianPractice NurseRegistered NurseSocial Care WorkerStudent - MedicalStudent - NursingStudent - TherapySupport WorkerTherapy AssistantOtherIf you selected Other, please specify* Do you currently carry out foot screening?* Yes No Patient A Jennifer is 24 years old and lives alone with her cat. She enjoys swimming and playing netball for her local netball team. Jennifer was diagnosed with type 1 diabetes at the age of 12 and has no other major health problems. Instructions You will be asked to populate the SCI-Diabetes form based on Jennifer’s details provided. Each form section will be pre-populated as if Jennifer does not have any problems, you must read her information which will be provided and amend accordingly. When you have populated the form with the findings of Jennifer’s screening you will then be asked what level of risk you think Jennifer is of developing an ulcer that could lead to an amputation. Patient details Jennifer's details have already been filled in so you can proceed to next section. Name: HUME, Jennifer CHI: 191255MNU Age: 24 Type of diabetes: 1Screening date DD slash MM slash YYYY Attendance: Attended and seen GP Practice name: Hope Medical Centre Postal address: 2 Albion Avenue, Capital City Postcode: GX9 5GH Amputation Jennifer has no amputations so the amputations section is therefore not activated. Right Amputation: none Date of amputation: n/a Diabetes related amputation: n/a Left Amputation: none Date of amputation: n/a Diabetes related amputation: n/a Risk factors Jennifer has no significant structural deformity or significant callus, and shows no signs of active ulceration or previous ulceration. She is able to self care. She has no Charcot foot and no recorded eGFR < 30. No other risk factors are identified. Significant structural abnormality of foot: Present | Absent ✓ Significant foot callus: Present | Absent ✓ Active ulceration: Yes | No ✓ Previous ulceration: Yes | No ✓ Able to or has help to self care: Yes ✓ | No Charcot foot: Active | Cosolidated | None ✓ Estimated GFR < 30 (glomerular filtration rate): Yes | No ✓ Other risk (specify): n/a Vascular screening Jennifer has both peripheral pulses present in each foot. No intermittent claudication or previous vascular intervention. You will need to select 'either present' for the Right and Left.RightPeripheral pulses (posterior tibial or dorsalis pedis) Either present Both absent Intermittent claudication: Yes | No ✓ Previous vascular intervention: Yes | No ✓LeftPeripheral pulses (posterior tibial or dorsalis pedis) Either present Both absent Intermittent claudication: Yes | No ✓ Previous vascular intervention: Yes | No ✓ Neurological screening Jennifer has sensation in all 10 sites. 10 gram monofilament sites: Present = Absent = Loss of protective sensation = No Feeling in less than 8 sites? Neurothesiometer assessment: Right: n/a mV | Left: n/a mV Painful neuropathy: Present | Absent ✓ Risk status Bearing in mind the information you have been given during Jennifer’s foot screening, what is her risk status? Q. What is Jennifer’s risk status? Active In remission High Moderate Low Sorry, you have assigned Jennifer as Active, this is incorrect. Jennifer is not at risk because she presents with no significant foot problems. Active Definition: Presence of active ulceration, infection, with or without ischaemia, gangrene or unexplained hot, red, swollen foot with or without the presence of pain. Action: Rapid referral to, and management by a member of the multidisciplinary diabetes foot team or directly to vascular when appropriate.Sorry, you have assigned Jennifer as Remission, this is incorrect. Jennifer is not at risk because she presents with no significant foot problems. In remission Definition: Previous ulceration, amputation or consolidated Charcot. Action: No further foot screening required as risk level will not reduce Implementation of a treatment/management plan by a podiatrist experienced in the diabetic foot agreed with the patient focused on preventing primary or recurrent ulceration according to patient needs and recorded on the SCI-Diabetes system Review of agreed treatment/management plan annually, as a minimum, according to patients needs and recorded on the SCI-Diabetes system Further review of patient’s own or prescription footwear and insoles by an orthotist/podiatrist, especially for those ‘In Remission’ Referral to other relevant specialists as required Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required Provide cardiovascular risk reduction information and encourage and signpost all smokers to a smoking cessation programme. Sorry, you have assigned Jennifer as High, this is incorrect. Jennifer is not at risk because she presents with no significant foot problems. High Definition: More than one risk factor present e.g. a combination of loss of sensation, signs of peripheral arterial disease, significant callus, significant structural deformity, unable to or has no help to self care or an eGFR <30. Action: No further foot screening required as risk level will not reduce Implementation of a treatment/management plan by a podiatrist experienced in the diabetic foot agreed with the patient focused on preventing primary or recurrent ulceration according to patient needs and recorded on the SCI-Diabetes system Review of agreed treatment/management plan annually, as a minimum, according to patients needs and recorded on the SCI-Diabetes system Further review of patient’s own or prescription footwear and insoles by an orthotist/podiatrist, especially for those ‘In Remission’ Referral to other relevant specialists as required Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required Provide cardiovascular risk reduction information and encourage and signpost all smokers to a smoking cessation programme. Sorry, you have assigned Jennifer as Moderate, this is incorrect. Jennifer is not at risk because she presents with no significant foot problems. Moderate Definition: One risk factor present e.g. loss of sensation or signs of peripheral arterial disease or significant callus or significant structural deformity or unable to or has no help to self care or an eGFR <30. Action: Annual screening (rather than every 2 years) by a trained Healthcare Worker recorded on the SCI-Diabetes foot screening page. Foot assessment by podiatrist when first identified as moderate risk (which may be a one off appointment) with the implementation of a treatment/management plan agreed with the patient if required. Consider the provision of prescription footwear and insoles if required, measured and fitted by an orthotist/podiatrist Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required Provide cardiovascular risk reduction information, encourage and signpost all smokers to a smoking cessation programme. Low risk Well done, Jennifer is Low risk because she presents with no significant foot problems or risks that put her at risk of ulceration which could lead to amputation. Low Definition: No risk factors present e.g. no loss of sensation, no signs of peripheral arterial disease, no significant callus, no significant structural deformity, able to self care and an eGFR >30. Action: Screening every two years by a trained Healthcare Worker recorded on the SCI-Diabetes foot screening page Agree personal foot care and self-care management plan with the patient Review footwear Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required. Provide cardiovascular risk reduction information and encourage and signpost all smokers to a smoking cessation programme. Referral status/education Jennifer requires no further referral so no changes need to be made to this section. Verbal and written foot education will be advised regarding self management. Education Written foot health education given: Yes ✓ | No Verbal foot health education given: Yes ✓ | No Form submission Thank you for completing this foot screening form, select 'Submit' to continue to the next patient. You have scored: 1/1 Patient B William is 62 years old. He was diagnosed with type 2 diabetes 2 years ago. He retired last year and enjoys working in his garden. Instructions You will be asked to populate the SCI-Diabetes form based on William's details provided. Each form section will be pre-populated as if William does not have any problems, you must read his information which will be provided and amend accordingly. When you have populated the form with the findings of William's screening you will then be asked what level of risk you think William is of developing an ulcer that could lead to an amputation. Patient details William's details have already been filled in so you can proceed to next section. Name: MARTINSON, William CHI: 1812453HNG Age: 62 Type of diabetes: 2Screening date DD slash MM slash YYYY Attendance: Attended and seen GP Practice name: Grange Medical Centre Postal address: 54 Rose Gardens, Inverness Postcode: IV9 6BH Amputation William has no amputations so the amputations section is therefore not activated. Right Amputation: none Date of amputation: n/a Diabetes related amputation: n/a Left Amputation: none Date of amputation: n/a Diabetes related amputation: n/a Risk factors William presents with a significant structural deformity of both feet and finds great difficulty in buying shoes from 'high street' shops that don't cause him discomfort. He does not attend a podiatrist. He shows no signs of active ulceration and has not had previous ulceration. He has no Charcot foot and no recorded eGFR < 30. He is able to self care and has no other risk factors. You will need to update the fields accordingly.Significant structural abnormality of foot Present Absent Significant foot callus Present Absent Active ulceration Yes No Previous ulceration Yes No Able to or has help to self care Yes No Charcot foot Active Cosolidated None Estimated GFR < 30 (glomerular filtration rate) Yes No Other risk Yes No Other risk (specify) Vascular screening William has both peripheral pulses present in each foot. No intermittent claudication or previous vascular intervention is present. You will need to select 'either present' for the Right and Left.RightRight peripheral pulses (posterior tibial or dorsalis pedis) Either present Both absent Intermittent claudication: Yes | No ✓ Previous vascular intervention: Yes | No ✓LeftLeft peripheral pulses (posterior tibial or dorsalis pedis) Either present Both absent Intermittent claudication: Yes | No ✓ Previous vascular intervention: Yes | No ✓ Neurological screening William has sensation in all 10 sites. He does not have painful neuropathy. 10 gram monofilament sites: Present = Absent = Loss of protective sensation = No Feeling in less than 8 sites? Neurothesiometer assessment: Right: n/a mV | Left: n/a mV Painful neuropathy: Present | Absent ✓ Risk status Bearing in mind the information you have been given during William’s foot screening, what is his risk status? Q. What is William's risk status? Active In remission High Moderate Low Sorry, you have assigned William as Active, this is incorrect. William is at risk because he presents with significant callus. Active Definition: Presence of active ulceration, infection, with or without ischaemia, gangrene or unexplained hot, red, swollen foot with or without the presence of pain. Action: Rapid referral to, and management by a member of the multidisciplinary diabetes foot team or directly to vascular when appropriate.Sorry, you have assigned William as Remission, this is incorrect. William is at risk because he presents with significant callus. In remission Definition: Previous ulceration, amputation or consolidated Charcot. Action: No further foot screening required as risk level will not reduce Implementation of a treatment/management plan by a podiatrist experienced in the diabetic foot agreed with the patient focused on preventing primary or recurrent ulceration according to patient needs and recorded on the SCI-Diabetes system Review of agreed treatment/management plan annually, as a minimum, according to patients needs and recorded on the SCI-Diabetes system Further review of patient’s own or prescription footwear and insoles by an orthotist/podiatrist, especially for those ‘In Remission’ Referral to other relevant specialists as required Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required Provide cardiovascular risk reduction information and encourage and signpost all smokers to a smoking cessation programme. Sorry, you have assigned William as High risk, this is incorrect. William is at risk because he presents with significant callus. High Definition: More than one risk factor present e.g. a combination of loss of sensation, signs of peripheral arterial disease, significant callus, significant structural deformity, unable to or has no help to self care or an eGFR <30. Action: No further foot screening required as risk level will not reduce Implementation of a treatment/management plan by a podiatrist experienced in the diabetic foot agreed with the patient focused on preventing primary or recurrent ulceration according to patient needs and recorded on the SCI-Diabetes system Review of agreed treatment/management plan annually, as a minimum, according to patients needs and recorded on the SCI-Diabetes system Further review of patient’s own or prescription footwear and insoles by an orthotist/podiatrist, especially for those ‘In Remission’ Referral to other relevant specialists as required Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required Provide cardiovascular risk reduction information and encourage and signpost all smokers to a smoking cessation programme. Sorry, you have assigned William as Low risk, this is incorrect. William is at risk because he presents with significant callus. Low Definition: No risk factors present e.g. no loss of sensation, no signs of peripheral arterial disease, no significant callus, no significant structural deformity, able to self care and an eGFR >30. Action: Screening every two years by a trained Healthcare Worker recorded on the SCI-Diabetes foot screening page Agree personal foot care and self-care management plan with the patient Review footwear Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required. Provide cardiovascular risk reduction information and encourage and signpost all smokers to a smoking cessation programme. Moderate risk Well done, William is Moderate risk because he presents with structural deformity. Moderate Definition: One risk factor present e.g. loss of sensation or signs of peripheral arterial disease or significant callus or significant structural deformity or unable to or has no help to self care or an eGFR <30. Action: Annual screening (rather than every 2 years) by a trained Healthcare Worker recorded on the SCI-Diabetes foot screening page. Foot assessment by podiatrist when first identified as moderate risk (which may be a one off appointment) with the implementation of a treatment/management plan agreed with the patient if required. Consider the provision of prescription footwear and insoles if required, measured and fitted by an orthotist/podiatrist Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required Provide cardiovascular risk reduction information, encourage and signpost all smokers to a smoking cessation programme. Referral status/education William requires referral to podiatry to see if he requires prescription footwear. Verbal and written foot education will be given by the podiatrist including information regarding self management. Refer William to: Dietetic District nurse Ophthalmologist Orthopaedic Orthotic Podiatry Practice nurse Vascular Other Other specify: Education Written foot health education given: Yes ✓ | No Verbal foot health education given: Yes ✓ | No Form submission Thank you for completing this foot screening form, select 'Submit' to continue to the next patient. You have scored: 2/2 Patient C Lynne is a 52 year old and was diagnosed with type 2 diabetes when she presented at her GP practice 9 months ago with an ulcer on the sole of her right foot. She did not know how it happened and it was not painful. She was immediately referred to her local foot ulcer clinic and after treatment the ulcer has subsequently healed. She now attends a podiatrist at her local health centre every 6 weeks for podiatry treatment. Instructions You will be asked to populate the SCI-Diabetes form based on Lynne's details provided. Each form section will be pre-populated as if Lynne does not have any problems, you must read her information which will be provided and amend accordingly. When you have populated the form with the findings of Lynne's screening you will then be asked what level of risk you think Lynne is of developing a further ulcer that could lead to an amputation. Patient details Lynne's details have already been filled in so you can proceed to next section. Name: PETERS, Lynne CHI: 1516467PKG Age: 52 Type of diabetes: 2Screening date DD slash MM slash YYYY Attendance: Attended and seen GP Practice name: Orchard Medical Practice Postal address: 73 Bailey Crescent, Forfar Postcode: DD8 1BG Amputation Lynne has no amputations so the amputations section is therefore not activated. Right Amputation: none Date of amputation: n/a Diabetes related amputation: n/a Left Amputation: none Date of amputation: n/a Diabetes related amputation: n/a Risk factors Lynne has significant callus on the soles of her feet. She has no significant structural abnormalities of her feet and no active ulceration. The ulcer she was suffering from has now healed. She is able to self care. She has no Charcot foot and no recorded eGFR < 30. No other risk factors are identified. You will need to update the fields accordingly.Significant structural abnormality of foot Present Absent Significant foot callus Present Absent Active ulceration Yes No Previous ulceration Yes No Able to or has help to self care Yes No Charcot foot Active Cosolidated None Estimated GFR < 30 (glomerular filtration rate) Yes No Other risk Yes No Other (please specify) Vascular screening Lynne has both peripheral pulses present in each foot. No intermittent claudication or previous vascular intervention. You will need to select 'either present' for the Right and Left.RightPeripheral pulses (posterior tibial or dorsalis pedis) Either present Both absent Intermittent claudication: Yes | No ✓ Previous vascular intervention: Yes | No ✓LeftPeripheral pulses (posterior tibial or dorsalis pedis) Either present Both absent Intermittent claudication: Yes | No ✓ Previous vascular intervention: Yes | No ✓ Neurological screening Lynne could not feel the monofilament on her R&L 1st apex, R3rd apex, R1st and R3rd Metatarsal heads. You will need to pick and click on the correct image below which reflects the findings of Lynne’s neurological screening. 10 gram monofilament sites: Present = Absent = Loss of protective sensation = Yes Lynne has loss of feeling in 5 sitesWhich image reflects Lynne's sites? A B C D Neurothesiometer assessment: Right: n/a mV | Left: n/a mVPainful Neuropathy Present Absent Risk status Bearing in mind the information you have been given during Lynne’s foot screening, what is her risk status? Q. What is Lynne's risk status? Active In remission High Moderate Low Sorry, you have assigned Lynne as Active, this is incorrect. Lynne is at risk because she has had previous ulceration, she has significant callus, and she suffers from neuropathy. Active Definition: Presence of active ulceration, infection, with or without ischaemia, gangrene or unexplained hot, red, swollen foot with or without the presence of pain. Action: Rapid referral to, and management by a member of the multidisciplinary diabetes foot team or directly to vascular when appropriate.Sorry, you have assigned Lynne as High, this is incorrect. Lynne is at risk because she has had previous ulceration, she has significant callus, and she suffers from neuropathy. High Definition: More than one risk factor present e.g. a combination of loss of sensation, signs of peripheral arterial disease, significant callus, significant structural deformity, unable to or has no help to self care or an eGFR <30. Action: No further foot screening required as risk level will not reduce Implementation of a treatment/management plan by a podiatrist experienced in the diabetic foot agreed with the patient focused on preventing primary or recurrent ulceration according to patient needs and recorded on the SCI-Diabetes system Review of agreed treatment/management plan annually, as a minimum, according to patients needs and recorded on the SCI-Diabetes system Further review of patient’s own or prescription footwear and insoles by an orthotist/podiatrist, especially for those ‘In Remission’ Referral to other relevant specialists as required Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required Provide cardiovascular risk reduction information and encourage and signpost all smokers to a smoking cessation programme. Sorry, you have assigned Lynne as Moderate, this is incorrect. Lynne is at risk because she has had previous ulceration, she has significant callus, and she suffers from neuropathy. Moderate Definition: One risk factor present e.g. loss of sensation or signs of peripheral arterial disease or significant callus or significant structural deformity or unable to or has no help to self care or an eGFR <30. Action: Annual screening (rather than every 2 years) by a trained Healthcare Worker recorded on the SCI-Diabetes foot screening page. Foot assessment by podiatrist when first identified as moderate risk (which may be a one off appointment) with the implementation of a treatment/management plan agreed with the patient if required. Consider the provision of prescription footwear and insoles if required, measured and fitted by an orthotist/podiatrist Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required Provide cardiovascular risk reduction information, encourage and signpost all smokers to a smoking cessation programme. Sorry, you have assigned Lynne as Low, this is incorrect. Lynne is at risk because she has had previous ulceration, she has significant callus, and she suffers from neuropathy. Low Definition: No risk factors present e.g. no loss of sensation, no signs of peripheral arterial disease, no significant callus, no significant structural deformity, able to self care and an eGFR >30. Action: Screening every two years by a trained Healthcare Worker recorded on the SCI-Diabetes foot screening page Agree personal foot care and self-care management plan with the patient Review footwear Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required. Provide cardiovascular risk reduction information and encourage and signpost all smokers to a smoking cessation programme. In Remission Well done, Lynne is In Remission because she has had previous ulceration, she has significant callus, and she suffers from neuropathy. In remission Definition: Previous ulceration, amputation or consolidated Charcot. Action: No further foot screening required as risk level will not reduce Implementation of a treatment/management plan by a podiatrist experienced in the diabetic foot agreed with the patient focused on preventing primary or recurrent ulceration according to patient needs and recorded on the SCI-Diabetes system Review of agreed treatment/management plan annually, as a minimum, according to patients needs and recorded on the SCI-Diabetes system Further review of patient’s own or prescription footwear and insoles by an orthotist/podiatrist, especially for those ‘In Remission’ Referral to other relevant specialists as required Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required Provide cardiovascular risk reduction information and encourage and signpost all smokers to a smoking cessation programme. Referral status/education Lynne is currently attending a specialist podiatrist for regular podiatric treatment/management and she is given further advice/education at each podiatry visit. No changes need to be made to this section. Education Written foot health education given: Yes ✓ | No Verbal foot health education given: Yes ✓ | No Form submission Thank you for completing this foot screening form, select 'Submit' to continue to the next patient. You have scored: 3/3 Patient D Reyansh is 72 years old and was diagnosed with Type 2 diabetes when he was 63 and considerably overweight. He had an ulcer on his R3rd toe 4 years ago which failed to heal and resulted in the toe being amputated. InstructionsYou will be asked to populate the SCI-Diabetes form based on Reyansh's details provided. Each form section will be pre-populated as if Reyansh does not have any problems, you must read his information which will be provided and amend accordingly. When you have populated the form with the findings of Reyansh's screening you will then be asked what level of risk you think Reyansh is of developing an ulcer that could lead to an amputation. Patient details Reyansh's details have already been filled in so you can proceed to next section. Name: KUMAR, Reyansh CHI: 7230663KJP Age: 72 Type of diabetes: 2Screening date DD slash MM slash YYYY Attendance: Attended and seen GP Practice name: Oaks Medical Centre Postal address: 62/1 Park Terrace, Glasgow Postcode: G12 5RV Amputation Reyansh had an ulcer on his R3rd toe 4 years ago which failed to heal and resulted in the toe being amputated on 27/8/2017. You will need to update the fields accordingly.Right footSelect oneNoneDigitTranstibialTransfemoralDate of amputation: 27/08/2017Diabetes related amputation Yes No Left footSelect oneNoneDigitTranstibialTransfemoralDate of amputation: n/a Diabetes related amputation: Yes | No ✓ Risk factors Reyansh has no significant callus or significant structural abnormalities and no active ulceration. He had a previous ulcer on his toe which resulted in it being amputated. He has no Charcot foot and no recorded eGFR < 30. He is unable to self care as he suffers from retinopathy which has resulted in him becoming visually impaired. You will need to update the fields accordingly.Significant structural abnormality of foot Present Absent Significant foot callus Present Absent Active ulceration Yes No Previous ulceration Yes No Able to or has help to self care Yes No Charcot foot Active Cosolidated None Estimated GFR < 30 (glomerular filtration rate) Yes No Other risk Yes No Other (please specify) Vascular screening Reyansh has both pulses absent in his R foot, posterior tibial pulse present on L foot. He does not suffer from intermittent claudication but has had previous vascular intervention in his right leg. You will need to update the fields accordingly.RightPeripheral pulses (posterior tibial or dorsalis pedis) Either present Both absent Intermittent claudication Yes No Previous vascular intervention Yes No LeftPeripheral pulses (posterior tibial or dorsalis pedis) Either present Both absent Intermittent claudication Yes No Previous vascular intervention Yes No Neurological screening Reyansh can feel all 9 remaining monofilament sites. 10 gram monofilament sites: Present = Absent = Loss of protective sensation = No Feeling in less than 8 sites? Neurothesiometer assessment: Right: n/a mV | Left: n/a mV Painful neuropathy: Present | Absent ✓ Risk status Bearing in mind the information you have been given during Reyansh’s foot screening, what is his risk status? Q. What is Reyansh's risk status? Active In remission High Moderate Low Sorry, you have assigned Reyansh as Active, this is incorrect. Reyansh is at risk because he has had a previous amputation, he suffers from PVD and absent pulses in his right foot, and he suffered from previous ulceration prior to his amputation. Active Definition: Presence of active ulceration, infection, with or without ischaemia, gangrene or unexplained hot, red, swollen foot with or without the presence of pain. Action: Rapid referral to, and management by a member of the multidisciplinary diabetes foot team or directly to vascular when appropriate.Sorry, you have assigned Reyansh as High, this is incorrect. Reyansh is at risk because he has had a previous amputation, he suffers from PVD and absent pulses in his right foot, and he suffered from previous ulceration prior to his amputation. High Definition: More than one risk factor present e.g. a combination of loss of sensation, signs of peripheral arterial disease, significant callus, significant structural deformity, unable to or has no help to self care or an eGFR <30. Action: No further foot screening required as risk level will not reduce Implementation of a treatment/management plan by a podiatrist experienced in the diabetic foot agreed with the patient focused on preventing primary or recurrent ulceration according to patient needs and recorded on the SCI-Diabetes system Review of agreed treatment/management plan annually, as a minimum, according to patients needs and recorded on the SCI-Diabetes system Further review of patient’s own or prescription footwear and insoles by an orthotist/podiatrist, especially for those ‘In Remission’ Referral to other relevant specialists as required Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required Provide cardiovascular risk reduction information and encourage and signpost all smokers to a smoking cessation programme. Sorry, you have assigned Reyansh as Moderate, this is incorrect. Reyansh is at risk because he has had a previous amputation, he suffers from PVD and absent pulses in his right foot, and he suffered from previous ulceration prior to his amputation. Moderate Definition: One risk factor present e.g. loss of sensation or signs of peripheral arterial disease or significant callus or significant structural deformity or unable to or has no help to self care or an eGFR <30. Action: Annual screening (rather than every 2 years) by a trained Healthcare Worker recorded on the SCI-Diabetes foot screening page. Foot assessment by podiatrist when first identified as moderate risk (which may be a one off appointment) with the implementation of a treatment/management plan agreed with the patient if required. Consider the provision of prescription footwear and insoles if required, measured and fitted by an orthotist/podiatrist Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required Provide cardiovascular risk reduction information, encourage and signpost all smokers to a smoking cessation programme. Sorry, you have assigned Reyansh as Low, this is incorrect. Reyansh is at risk because he has had a previous amputation, he suffers from PVD and absent pulses in his right foot, and he suffered from previous ulceration prior to his amputation. Low Definition: No risk factors present e.g. no loss of sensation, no signs of peripheral arterial disease, no significant callus, no significant structural deformity, able to self care and an eGFR >30. Action: Screening every two years by a trained Healthcare Worker recorded on the SCI-Diabetes foot screening page Agree personal foot care and self-care management plan with the patient Review footwear Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required. Provide cardiovascular risk reduction information and encourage and signpost all smokers to a smoking cessation programme. In Remission Well done, Reyansh is In Remission risk because he has had a previous amputation, he suffers from PVD and absent pulses in his right foot, and he suffered from previous ulceration prior to his amputation. In remission Definition: Previous ulceration, amputation or consolidated Charcot. Action: No further foot screening required as risk level will not reduce Implementation of a treatment/management plan by a podiatrist experienced in the diabetic foot agreed with the patient focused on preventing primary or recurrent ulceration according to patient needs and recorded on the SCI-Diabetes system Review of agreed treatment/management plan annually, as a minimum, according to patients needs and recorded on the SCI-Diabetes system Further review of patient’s own or prescription footwear and insoles by an orthotist/podiatrist, especially for those ‘In Remission’ Referral to other relevant specialists as required Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required Provide cardiovascular risk reduction information and encourage and signpost all smokers to a smoking cessation programme. Referral status/education Reyansh is currently attending a specialist podiatrist for regular podiatric treatment/management. He is still struggling to control his weight and would benefit from being referred to a dietician.Refer Reyansh to: Dietetic District nurse Ophthalmologist Orthopaedic Orthotic Podiatry Practice nurse Vascular Other Other specify: Education Written foot health education given: Yes ✓ | No Verbal foot health education given: Yes ✓ | No Form submission Thank you for completing this foot screening form, select 'Submit' to continue to the next patient. You have scored: 4/4 Patient E John is 37 years old and was diagnosed with Type 1 when he was 12. He lives with his partner has two young children and keeps fit by visiting the gym 3 times a week. InstructionsYou will be asked to populate the SCI-Diabetes form based on John's details provided. Each form section will be pre-populated as if John does not have any problems, you must read his information which will be provided and amend accordingly. When you have populated the form with the findings of John's screening you will then be asked what level of risk you think John is of developing an ulcer that could lead to an amputation. Patient details John's details have already been filled in so you can proceed to next section. Name: CAPALDI, John CHI: 886406631YRF Age: 37 Type of diabetes: 1Screening date DD slash MM slash YYYY Attendance: Attended and seen GP Practice name: Teviot Medical Centre Postal address: 3 Leaburn Crescent, Hawick Postcode: TD9 7JU Amputation John has no amputations so the amputations section is therefore not activated. Right Amputation: none Date of amputation: n/a Diabetes related amputation: n/a Left Amputation: none Date of amputation: n/a Diabetes related amputation: n/a Risk factors John has no significant callus or significant structural abnormalities. He has no active ulceration or previous ulceration. He is able to self care. He has no Charcot foot and no recorded eGFR < 30. No other risk factors have been identified. Significant structural abnormality of foot: Present | Absent ✓ Significant foot callus: Present | Absent ✓ Active ulceration: Yes | No ✓ Previous ulceration: Yes | No ✓ Able to or has help to self care: Yes ✓ | No Charcot foot: Active | Cosolidated | None ✓ Estimated GFR < 30 (glomerular filtration rate): Yes | No ✓ Other risk (specify): n/a Vascular screening John has both pulses present on both feet. No intermittent claudication or previous vascular intervention. You will need to select 'either present' for the Right and Left.RightPeripheral pulses (posterior tibial or dorsalis pedis) Either present Both absent Intermittent claudication: Yes | No ✓ Previous vascular intervention: Yes | No ✓LeftPeripheral pulses (posterior tibial or dorsalis pedis) Either present Both absent Intermittent claudication: Yes | No ✓ Previous vascular intervention: Yes | No ✓ Neurological screening John can feel all 10 monofilament sites. 10 gram monofilament sites: Present = Absent = Loss of protective sensation = No Feeling in less than 8 sites? Neurothesiometer assessment: Right: n/a mV | Left: n/a mV Painful neuropathy: Present | Absent ✓ Risk status Bearing in mind the information you have been given during John’s foot screening, what is his risk status? Q. What is John's risk status? Active In remission High Moderate Low Sorry, you have assigned John as Active, this is incorrect. John is not at risk because he has no risk factors that would put him at risk of ulceration. Active Definition: Presence of active ulceration, infection, with or without ischaemia, gangrene or unexplained hot, red, swollen foot with or without the presence of pain. Action: Rapid referral to, and management by a member of the multidisciplinary diabetes foot team or directly to vascular when appropriate.Sorry, you have assigned John as Remission, this is incorrect. John is not at risk because he has no risk factors that would put him at risk of ulceration. In remission Definition: Previous ulceration, amputation or consolidated Charcot. Action: No further foot screening required as risk level will not reduce Implementation of a treatment/management plan by a podiatrist experienced in the diabetic foot agreed with the patient focused on preventing primary or recurrent ulceration according to patient needs and recorded on the SCI-Diabetes system Review of agreed treatment/management plan annually, as a minimum, according to patients needs and recorded on the SCI-Diabetes system Further review of patient’s own or prescription footwear and insoles by an orthotist/podiatrist, especially for those ‘In Remission’ Referral to other relevant specialists as required Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required Provide cardiovascular risk reduction information and encourage and signpost all smokers to a smoking cessation programme. Sorry, you have assigned John as High, this is incorrect. John is not at risk because he has no risk factors that would put him at risk of ulceration. High Definition: More than one risk factor present e.g. a combination of loss of sensation, signs of peripheral arterial disease, significant callus, significant structural deformity, unable to or has no help to self care or an eGFR <30. Action: No further foot screening required as risk level will not reduce Implementation of a treatment/management plan by a podiatrist experienced in the diabetic foot agreed with the patient focused on preventing primary or recurrent ulceration according to patient needs and recorded on the SCI-Diabetes system Review of agreed treatment/management plan annually, as a minimum, according to patients needs and recorded on the SCI-Diabetes system Further review of patient’s own or prescription footwear and insoles by an orthotist/podiatrist, especially for those ‘In Remission’ Referral to other relevant specialists as required Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required Provide cardiovascular risk reduction information and encourage and signpost all smokers to a smoking cessation programme. Sorry, you have assigned John as Moderate, this is incorrect. John is not at risk because he has no risk factors that would put him at risk of ulceration. Moderate Definition: One risk factor present e.g. loss of sensation or signs of peripheral arterial disease or significant callus or significant structural deformity or unable to or has no help to self care or an eGFR <30. Action: Annual screening (rather than every 2 years) by a trained Healthcare Worker recorded on the SCI-Diabetes foot screening page. Foot assessment by podiatrist when first identified as moderate risk (which may be a one off appointment) with the implementation of a treatment/management plan agreed with the patient if required. Consider the provision of prescription footwear and insoles if required, measured and fitted by an orthotist/podiatrist Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required Provide cardiovascular risk reduction information, encourage and signpost all smokers to a smoking cessation programme. Low risk Well done, John is low risk because he has no risk factors that would put him at risk of ulceration. Low Definition: No risk factors present e.g. no loss of sensation, no signs of peripheral arterial disease, no significant callus, no significant structural deformity, able to self care and an eGFR >30. Action: Screening every two years by a trained Healthcare Worker recorded on the SCI-Diabetes foot screening page Agree personal foot care and self-care management plan with the patient Review footwear Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required. Provide cardiovascular risk reduction information and encourage and signpost all smokers to a smoking cessation programme. Referral status/education He does not attend a podiatrist but has his feet screened each year by the practice nurse in his GP practice who gives him advice on self management. No changes need to be made to this section. Education Written foot health education given: Yes ✓ | No Verbal foot health education given: Yes ✓ | No Form submission Thank you for completing this foot screening form, select 'Submit' to continue to the next patient. You have scored: 5/5 Patient F Donald is 59 years old and has suffered from poorly controlled Type 2 diabetes for 5 years. He took early retirement 2 years ago and lives at home with his wife Mary. InstructionsYou will be asked to populate the SCI-Diabetes form based on Donald's details provided. Each form section will be pre-populated as if Donald does not have any problems, you must read his information which will be provided and amend accordingly. When you have populated the form with the findings of Donald's screening you will then be asked what level of risk you think Donald is of developing an ulcer that could lead to an amputation. Patient details Donald's details have already been filled in so you can proceed to next section. Name: SMITH-BROWN, Donald CHI: 437857RDH Age: 59 Type of diabetes: 2Screening date DD slash MM slash YYYY Attendance: Attended and seen GP Practice name: Springwell Medical Centre Postal address: 64 Beech Road, Laurencekirk Postcode: AB13 5PY Amputation Donald has no amputations so the amputations section is therefore not activated. Right Amputation: none Date of amputation: n/a Diabetes related amputation: n/a Left Amputation: none Date of amputation: n/a Diabetes related amputation: n/a Risk factors Donald has no significant callus or significant structural abnormalities. He has no active ulceration or previous ulceration. He is able to self care. He has no Charcot foot and no recorded eGFR < 30. No other risk factors have been identified. Significant structural abnormality of foot: Present | Absent ✓ Significant foot callus: Present | Absent ✓ Active ulceration: Yes | No ✓ Previous ulceration: Yes | No ✓ Able to or has help to self care: Yes ✓ | No Charcot foot: Active | Cosolidated | None ✓ Estimated GFR < 30 (glomerular filtration rate): Yes | No ✓ Other risk (specify): n/a Vascular screening Donald has both pulses present on both feet. No intermittent claudication or previous vascular intervention. You will need to select 'either present' for the Right and Left.RightPeripheral pulses (posterior tibial or dorsalis pedis) Either present Both absent Intermittent claudication: Yes | No ✓ Previous vascular intervention: Yes | No ✓LeftPeripheral pulses (posterior tibial or dorsalis pedis) Either present Both absent Intermittent claudication: Yes | No ✓ Previous vascular intervention: Yes | No ✓ Neurological screening Donald could not feel the monofilament on his R1st apex, R3rd apex, R1st metatarsal head, L1st apex and L3rd apex. You will need to pick and click on the correct image below which reflects the findings of Donald’s neurological screening. 10 gram monofilament sites: Present = Absent = Loss of protective sensation = Yes Donald has loss of feeling in 5 sitesWhich image reflect's Donald's sites? A B C D Neurothesiometer assessment: Right: n/a mV | Left: n/a mVPainful neuropathy Present Absent Risk status Bearing in mind the information you have been given during Donald’s foot screening, what is his risk status? Q. What is Donald's risk status? Active In remission High Moderate Low Sorry, you have assigned Donald as Active, this is incorrect. Donald is at risk because he suffers from neuropathy as he could only feel 5/10 of the monofilament sites. Active Definition: Presence of active ulceration, infection, with or without ischaemia, gangrene or unexplained hot, red, swollen foot with or without the presence of pain. Action: Rapid referral to, and management by a member of the multidisciplinary diabetes foot team or directly to vascular when appropriate.Sorry, you have assigned Donald as Remission, this is incorrect. Donald is at risk because he suffers from neuropathy as he could only feel 5/10 of the monofilament sites. In remission Definition: Previous ulceration, amputation or consolidated Charcot. Action: No further foot screening required as risk level will not reduce Implementation of a treatment/management plan by a podiatrist experienced in the diabetic foot agreed with the patient focused on preventing primary or recurrent ulceration according to patient needs and recorded on the SCI-Diabetes system Review of agreed treatment/management plan annually, as a minimum, according to patients needs and recorded on the SCI-Diabetes system Further review of patient’s own or prescription footwear and insoles by an orthotist/podiatrist, especially for those ‘In Remission’ Referral to other relevant specialists as required Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required Provide cardiovascular risk reduction information and encourage and signpost all smokers to a smoking cessation programme. Sorry, you have assigned Donald as High, this is incorrect. Donald is at risk because he suffers from neuropathy as he could only feel 5/10 of the monofilament sites. High Definition: More than one risk factor present e.g. a combination of loss of sensation, signs of peripheral arterial disease, significant callus, significant structural deformity, unable to or has no help to self care or an eGFR <30. Action: No further foot screening required as risk level will not reduce Implementation of a treatment/management plan by a podiatrist experienced in the diabetic foot agreed with the patient focused on preventing primary or recurrent ulceration according to patient needs and recorded on the SCI-Diabetes system Review of agreed treatment/management plan annually, as a minimum, according to patients needs and recorded on the SCI-Diabetes system Further review of patient’s own or prescription footwear and insoles by an orthotist/podiatrist, especially for those ‘In Remission’ Referral to other relevant specialists as required Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required Provide cardiovascular risk reduction information and encourage and signpost all smokers to a smoking cessation programme. Sorry, you have assigned Donald as Low, this is incorrect. Donald is at risk because he suffers from neuropathy as he could only feel 5/10 of the monofilament sites. Low Definition: No risk factors present e.g. no loss of sensation, no signs of peripheral arterial disease, no significant callus, no significant structural deformity, able to self care and an eGFR >30. Action: Screening every two years by a trained Healthcare Worker recorded on the SCI-Diabetes foot screening page Agree personal foot care and self-care management plan with the patient Review footwear Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required. Provide cardiovascular risk reduction information and encourage and signpost all smokers to a smoking cessation programme. Moderate risk Well done, Donald is Moderate risk because he suffers from neuropathy as he could only feel 5/10 of the monofilament sites. Moderate Definition: One risk factor present e.g. loss of sensation or signs of peripheral arterial disease or significant callus or significant structural deformity or unable to or has no help to self care or an eGFR <30. Action: Annual screening (rather than every 2 years) by a trained Healthcare Worker recorded on the SCI-Diabetes foot screening page. Foot assessment by podiatrist when first identified as moderate risk (which may be a one off appointment) with the implementation of a treatment/management plan agreed with the patient if required. Consider the provision of prescription footwear and insoles if required, measured and fitted by an orthotist/podiatrist Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required Provide cardiovascular risk reduction information, encourage and signpost all smokers to a smoking cessation programme. Referral status/education Donald will need to be referred to a podiatrist as he is moderate risk due to his neuropathy and is currently not attending a podiatrist. Verbal and written foot education will be given regarding his neuropathy.Refer Donald to: Dietetic District nurse Ophthalmologist Orthopaedic Orthotic Podiatry Practice nurse Vascular Other Other specify: Education Written foot health education given: Yes ✓ | No Verbal foot health education given: Yes ✓ | No Form submission Thank you for completing this foot screening form, select 'Submit' to continue to the next patient. You have scored: 6/6 Patient G Magda is 47 years old and lives with her husband and 3 children. Magda was diagnosed with Type II diabetes 3 years ago. Her busy lifestyle means she struggles to control her diabetes as well as her weight. InstructionsYou will be asked to populate the SCI-Diabetes form based on Magda's details provided. Each form section will be pre-populated as if Magda does not have any problems, you must read her information which will be provided and amend accordingly. When you have populated the form with the findings of Magda's screening you will then be asked what level of risk you think Magda is of developing an ulcer that could lead to an amputation. Patient details Magda's details have already been filled in so you can proceed to next section. Name: ROLOWZKI, Magda CHI: 3756038MSC Age: 47 Type of diabetes: 2Screening date DD slash MM slash YYYY Attendance: Attended and seen GP Practice name: Ashley Medical Centre Postal address: 29 Cross Road, Perth Postcode: PH19 9CB Amputation Magda has no amputations so the amputations section is therefore not activated. Right Amputation: none Date of amputation: n/a Diabetes related amputation: n/a Left Amputation: none Date of amputation: n/a Diabetes related amputation: n/a Risk factors Magda has a significant structural deformity and a significant callus, she shows no signs of active ulceration or previous ulceration. She is able to self care. She has no Charcot foot but has a recorded eGFR <= 14. No other risk factors are identified. You will need to update the fields accordingly.Significant structural abnormality of foot Present Absent Significant foot callus Present Absent Active ulceration Yes No Previous ulceration Yes No Able to or has help to self care Yes No Charcot foot Active Cosolidated None Estimated GFR < 30 (glomerular filtration rate): Yes ✓ | No Magda's eGFR ≤ 14Other risk Yes No Other (please specify) Vascular screening Magda has both peripheral pulses present in each foot. No intermittent claudication or previous vascular intervention. You will need to select 'either present' for the Right and Left.RightPeripheral pulses (posterior tibial or dorsalis pedis) Either present Both absent Intermittent claudication: Yes | No ✓ Previous vascular intervention: Yes | No ✓LeftPeripheral pulses (posterior tibial or dorsalis pedis) Either present Both absent Intermittent claudication: Yes | No ✓ Previous vascular intervention: Yes | No ✓ Neurological screening Magda has sensation in all 10 sites. 10 gram monofilament sites: Present = Absent = Loss of protective sensation = No Feeling in less than 8 sites? Neurothesiometer assessment: Right: n/a mV | Left: n/a mV Painful neuropathy: Present | Absent ✓ Risk status Bearing in mind the information you have been given during Magda’s foot screening, what is her risk status? Q. What is Magda's risk status? Active In remission High Moderate Low Sorry, you have assigned Magda as Active, this is incorrect. Magda is at risk because she presents with a significant structural deformity, a significant callus and an eGFR <= 15. Active Definition: Presence of active ulceration, infection, with or without ischaemia, gangrene or unexplained hot, red, swollen foot with or without the presence of pain. Action: Rapid referral to, and management by a member of the multidisciplinary diabetes foot team or directly to vascular when appropriate.Sorry, you have assigned Magda as Remission, this is incorrect. Magda is at risk because she presents with a significant structural deformity, a significant callus and an eGFR <= 15. In remission Definition: Previous ulceration, amputation or consolidated Charcot. Action: No further foot screening required as risk level will not reduce Implementation of a treatment/management plan by a podiatrist experienced in the diabetic foot agreed with the patient focused on preventing primary or recurrent ulceration according to patient needs and recorded on the SCI-Diabetes system Review of agreed treatment/management plan annually, as a minimum, according to patients needs and recorded on the SCI-Diabetes system Further review of patient’s own or prescription footwear and insoles by an orthotist/podiatrist, especially for those ‘In Remission’ Referral to other relevant specialists as required Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required Provide cardiovascular risk reduction information and encourage and signpost all smokers to a smoking cessation programme. Sorry, you have assigned Magda as Moderate, this is incorrect. Magda is at risk because she presents with a significant structural deformity, a significant callus and an eGFR <= 15. Moderate Definition: One risk factor present e.g. loss of sensation or signs of peripheral arterial disease or significant callus or significant structural deformity or unable to or has no help to self care or an eGFR <30. Action: Annual screening (rather than every 2 years) by a trained Healthcare Worker recorded on the SCI-Diabetes foot screening page. Foot assessment by podiatrist when first identified as moderate risk (which may be a one off appointment) with the implementation of a treatment/management plan agreed with the patient if required. Consider the provision of prescription footwear and insoles if required, measured and fitted by an orthotist/podiatrist Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required Provide cardiovascular risk reduction information, encourage and signpost all smokers to a smoking cessation programme. Sorry, you have assigned Magda as Low, this is incorrect. Magda is at risk because she presents with a significant structural deformity, a significant callus and an eGFR <= 15. Low Definition: No risk factors present e.g. no loss of sensation, no signs of peripheral arterial disease, no significant callus, no significant structural deformity, able to self care and an eGFR >30. Action: Screening every two years by a trained Healthcare Worker recorded on the SCI-Diabetes foot screening page Agree personal foot care and self-care management plan with the patient Review footwear Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required. Provide cardiovascular risk reduction information and encourage and signpost all smokers to a smoking cessation programme. High risk Well done, Magda is High risk because she presents with a significant structural deformity, a significant callus and an eGFR < 30. High Definition: More than one risk factor present e.g. a combination of loss of sensation, signs of peripheral arterial disease, significant callus, significant structural deformity, unable to or has no help to self care or an eGFR <30. Action: No further foot screening required as risk level will not reduce Implementation of a treatment/management plan by a podiatrist experienced in the diabetic foot agreed with the patient focused on preventing primary or recurrent ulceration according to patient needs and recorded on the SCI-Diabetes system Review of agreed treatment/management plan annually, as a minimum, according to patients needs and recorded on the SCI-Diabetes system Further review of patient’s own or prescription footwear and insoles by an orthotist/podiatrist, especially for those ‘In Remission’ Referral to other relevant specialists as required Provide written and verbal education including information on how to access podiatry (urgent or otherwise) as required Provide cardiovascular risk reduction information and encourage and signpost all smokers to a smoking cessation programme. Referral status/education As Magda struggles to control her weight she should be referred to the dietician. Verbal and written foot education will be given and she is referred for education regarding self management.Refer Magda to: Dietetic District nurse Ophthalmologist Orthopaedic Orthotic Podiatry Practice nurse Vascular Other Other specify: Education Written foot health education given: Yes ✓ | No Verbal foot health education given: Yes ✓ | No Form submission Thank you for completing this foot screening form, select 'Submit' to complete the test. You have scored: 7/7 Module quiz (NHS Scotland) Module quiz (NHS Scotland)Module quiz
