Implementation of a foot assessment program in a regional satellite hemodialysis setting.

Individuals with chronic kidney disease are at higher risk for foot problems (i.e., ulcers, deformities, amputations) than the general population. Research demonstrates that assessment and active monitoring, teaching, and timely interventions can reduce the number and severity of lower limb amputations in the hemodialysis population. This paper reports on a quality improvement project aimed at implementation of a foot assessment program in a regional satellite hemodialysis setting based on the Registered Nurses' Association of Ontario's (2005) best practice guideline (BPG), The Assessment and Management of Foot Ulcers for People with Diabetes. Elements of the program include a one-time full assessment of risk for all patients transferring to the satellite program followed by monthly foot checks for those deemed high risk (i.e., people with diabetes). Evaluation of the program has been positive from both patients and hemodialysis nursing staff. There has been a greater emphasis on self-management around the care and management of patients and their high-risk feet. At the same time, the program has resulted in prompt identification of problems and timelier referral to the appropriate services in the patient's local community.