The prevalence of diabetes is increasing in all age groups and thus it it is important to ensure that this group of people take care of themselves to prevent further complications from happening. The Pharmacy Quality Scheme, PQS that was recently announced as part of the new 5 year Community Pharmacy Contractual Framework includes an audit to ask patients over the age of 12 with diabetes whether they have had their annual foot and eye check.
The Pharmacy Quality Scheme
The PQS is made up of six composite bundles one of which is the Prevention bundle which contains several different criteria one of which is the audit.
To qualify, pharmacies must confirm that all patients presenting with diabetes from 1st October 2019 to the 31st January 2020 have had foot and eye checks (retinopathy) in the last 12 months. Remember that foot and eye checks are only for diabetic patients aged 12 or older.
The pharmacy must record the patient’s response on the PMR, relevant form or patient record. This should indicate the total number of patients who have had these checks and those who did not in the last 12 months. As part of the criteria, it must also reflect that the patients have been appropriately signposted/referred.
Foot Checks And Diabetes
There is a higher risk of foot problems in people with diabetes as a result of diabetic neuropathy (nerve damage or degeneration) or peripheral arterial disease (poor blood supply due to diseased blood vessels in the legs), or both. Recent statistics show that peripheral arterial disease affects 1 in 3 people with diabetes over the age of 50. It can also increase the risk of heart attack and stroke which makes foot checks even more important.
Foot problems in people with diabetes also greatly impact the NHS financially through primary care, community care, outpatient costs, increased bed occupancy and prolonged hospital stays. A 2012 report by NHS Diabetes estimated that around £650 million is spent on foot ulcers or amputations every year. That equates to £1 in every £150 the NHS spends.
Preventing Serious Foot Problems
Serious foot problems can often be prevented by performing regular and thorough checks. Patients with Type 1 and Type 2 diabetes should check their feet daily and those 12 years and older should have an annual foot check by a the relevant healthcare professional.
When it comes to children with diabetes under 12 years, their parents or carers should be given basic foot care advice rather than asking the child to go for an assessment. This is what you can expect from at your annual foot check.
Foot problems can cause many complications such as athlete’s foot, fungal nail infections, calluses, corns, blisters, bunions, dry skin, sores, hammertoes, ingrown toenails and plantar warts. While anyone can present with these problems, they are more serious in people suffering from diabetes. Here is why:
- If they have nerve damage, they may not feel small wounds that require medical treatment
- Poor blood flow can also result in wounds healing much slower
- If their immune system is suppressed, they may be more prone to infections
- Damaged muscle nerves could prevent their foot from aligning properly. This results in applying uneven pressure in one area of the foot causing foot sores and pressure point ulcers.
- Diabetes is also the leading cause of lower limb amputations in the UK and someone living with diabetes is 20 times more likely to have an amputation than someone who hasn’t got the condition.From 2014 to 2017 a record 169 UK patients a week had a diabetic related amputation.
Frequency Of Foot Checks
Young people with diabetes who are 12–17 years old should have their feet assessed by the paediatric care team or the transitional care team. As part of the annual assessment, they will also provide the necessary information about proper foot care. If the team finds or suspects a diabetic foot problem, they should refer them to an appropriate specialist as soon as possible.
Adults suffering from diabetes should be assessed as follows:
- when they are diagnosed with diabetes and at least annually thereafter
- if any foot problems are present
- on admission to hospital and if there is a change in their status while in hospital
While children under 12 needs from being asked about annual foot checks, pharmacy teams should provide them and their family or carers with the Diabetes UK ‘Simple steps to healthy feet if you’ve got diabetes’.
Diabetic Eye Screening
Did you know that diabetes causes serious sight problems to more than 1,700 people in the UK every year? Diabetics should have regular eye screening as part of their essential checks as it can lead to eye damage referred to as retinopathy. Diabetic retinopathy is a complication of diabetes which is caused by high blood glucose levels damaging the retina.
Diabetic patients have a much higher risk of eye problems which could lead to sight loss if left untreated. Annual eye screening is offered to all people with diabetes aged 12 years and older. This is done in an effort to identify and treat any problems early on. To minimise the risk of blindness, diabetic patients with Type 1 and Type 2 should do the following:
- properly control their blood glucose levels, blood pressure and cholesterol
- never miss a diabetic eye screening appointment
Who Performs The Eye Check?
Generally, a patient’s GP practice doesn’t perform the diabetic eye screening. They refer patients older than 12 years with diabetes to a single National Diabetic Eye Screening Programme (NDESP) provider. They will contact the patient to make an appointment or to provide contact details to make arrangements themselves.
If someone misses an appointment or neglects to make one, the NDESP provider should try to contact the patient again. The NDESP provider should inform the patient’s GP of any test results and whether they attended or not.
Effective Eye Care Tips
Regular eye checks will help patients keep track of their eye health while reducing their risk of serious complications. There are a few simple eye care tips for patients that will help in addition to diabetic eye screening:
- take note of any changes in sight including floaters, dimmer vision or difficulty seeing in the dark
- make sure they know their target blood sugar levels, blood pressure and cholesterol
- follow a balanced and healthy diet
- be as active as possible and stop smoking
Pharmacy Quality Scheme Criteria Requirements
As mentioned earlier, the activity period for this particular criterion is from 1 October 2019 to 31 January 2020. To meet the criteria, community pharmacy teams must ensure that they speak to all patients who present with diabetes 12 years and older within this time period. Pharmacy teams need to ask patients, including those in care homes and those who have their prescriptions delivered, if they have had an eye and foot check within the last 12 months. Pharmacies only need to speak to a patient on one occasion.
VirtualOutcomes has an online course to support pharmacy teams in successfully implementing the audit. It also includes resources such as a template audit sheet and summary sheet. Please contact us for more information and join the conversation on Facebook, Twitter and LinkedIn.