Implementation of an evidence-based diabetic foot risk stratification pathway in a surgical outpatient setting: a best practice implementation project.

BACKGROUND

Diabetic foot ulcers are a severe complication of diabetes. Despite international guidelines, preventive risk assessment remains inconsistent in outpatient settings.

OBJECTIVES

The project aimed to improve early identification and risk stratification of diabetic foot in a plastic surgery outpatient department in Taiwan through the implementation of evidence-based practices.

METHODS

This best practice implementation project utilized the JBI Evidence Implementation Framework. A baseline audit of 30 patient records was conducted to evaluate current practice against best practice recommendations. Barriers were identified using JBI's GRiP (Getting Research into Practice) tool. Improvement strategies included developing a standard operating procedure, embedding risk assessment forms in the electronic health record, and staff training. A follow-up audit of 38 records evaluated post-implementation compliance.

RESULTS

Baseline compliance was 0% for standardized risk classification and staff training. Following the implementation of targeted strategies over 5 months, compliance improved to 100% across all six audit criteria. However, short-term clinical outcomes revealed persistent adverse events, including one death, four hospitalizations, and two amputations, highlighting a gap between process compliance and immediate outcome improvement.

CONCLUSIONS

The project successfully established a high-reliability preventive process for diabetic foot care in an outpatient setting. However, the persistence of adverse outcomes suggests that process improvement must be coupled with longitudinal follow-up and robust post-assessment care pathways to effectively reduce amputation rates.

SPANISH ABSTRACT: https://links.lww.com/IJEBH/A696.