feet first- delivering safe foot care key first... · 2018-10-23 · basic (bfc) vs advanced (afc)...

Feet First: Delivering Safe Foot Care

Alison Petten RN BScN Educator / Health Consultant

(902) 453-2737 [email protected]

www.caringeducation.ca!1

1 Feet First- Delivering Safe Foot Care KEY - October 21, 2018

Thank you for caring!■ poor ol’ feet ■ undervalued and disliked by many ■ In a narrow shoe with a high heel we put

26 bones, 33 joints, >100 ligaments. ■ This amazing work of natural science

‘mobile adaptor’ changes structure as we walk, stand, run, sleep. It’s incredible!

■ Finally more attention and understanding


Foot Care (45 minutes)■ What is foot care? ■ Basic vs Advanced FC ■ What Makes Foot Care Safe or Unsafe? ■ Foot Care: IPC and Reprocessing ■ Tips for Continuing Care Leaders

■ 30 minutes slides + 15 minutes Q&A


Advanced & Diabetic Nursing Foot Care (FCNS 2018)

■ based on a comprehensive assessment ■ Nursing Process (A-P-I-E) ■ SoP, CoE, Documentation Guidelines, + ■ noninvasive and conservative ■ at the level of the epidermis ■ emphasis on education, prevention of

problems, management of chronic problems and referral to appropriate health professionals


Basic Foot Care■ Multiple definitions ■ Provided by nurses and other caregivers

i.e. PCWs, CCAs, HSWs, family ■ Nurses - must use NP etc ■ If have not taken an ‘advanced’ course

will have different/less knowledge, skill and ability

■ LPNs must have an advanced course if client has pathology related to feet


Basic Foot Care (FCNS 2018)

■ for lower risk and higher risk clients ■ Basic is not minimal. It is foundational and very

important. It is potentially life-saving. ■ Everyone needs basics of looking and feeling, hygiene

and moisture. (inspection, palpation, IPC, skin integrity) ■ astute observations = looking and feeling with

knowledge ■ cleaning, drying and moisturizing ■ (? trimming nails) ■ filing nails (? and calluses) ■ (many different definitions) ■ common priority: wash and dry well between/under toes


Basic (BFC) vs Advanced (AFC)■ Everyone needs BFC ! ■ Some clients also need AFC. If so, still

need basic too. ■ Higher risk clients are at increased risk if

a ‘policy’ keeps caregivers from doing the regular basics. (ex. PWD needs daily inspection and hygiene.)

■ Fear has resulted in some well-intentioned but harmful practices.


Safe Foot Care Includes …■ Comprehensive assessment - with the

knowledge, skill and ability to do so ■ Individualized plan of care - often simple ■ Plan is communicated, followed by team ■ Includes BFC + AFC prn ■ w/in Scope of Practice ■ Evaluated ■ Followed up ■ Appropriate IPC measures


Safe Foot Care Notes■ Includes management of CVI, PAD and mixed

disease, footwear, mobility issues, education of client/other caregivers and more - not just nail care

■ F/U as needed, incident reporting, 1st Aid ■ Common- compression inappropriate or not

applied properly ■ Most simple things - easy right or wrong ■ Accessible/provided care is safer :-)


Comprehensive Nsg FC Assessment■ Health Hx, Management, Risk Factors ■ Gait, Footwear, Mobility ■ Integument ■ Lower limb bony structure and ROM ■ Sensation ■ Circulation; venous, arterial, mixed ■ Self-management (knowledge, education,

referral, resources needed)


Nursing FC Must be Wholistic■ Legislated ■ “FC Nurses don’t take care of feet. They

take care of people who have feet.” (FCNS 2018) ■ Not a pedicure. ■ Provided by a self-regulated nurse who

must meet SoP, follow CoE work within Scope of Practice

■ Refer to definition slide #4


Some Providers of ‘Foot Care’■ CCAs ■ LPNs and RNs ■ Podiatrists / Chiropodists ■ Pedorthists ■ FamMD ■ Primary Care NP ■ Orthopedic Surgeons ■ Dermatologists ■ Pharmacists


Unsafe Foot Care■ Basic FC not provided (wash/dry ‘foot’, not btn/under toes) ■ Advanced FC provider not requested prn (FC nurse,

podiatrist, pedorthist, MD, pharmacist, dermatologist) ■ Without comprehensive assessment 1st ■ Outside scope of practice ■ Inadequate communication of plan and outcomes ■ Policies/practices developed w/o evidence and/or bc of fear ■ Using unreprocessed instruments ■ Not following manufacturer’s guidelines ■ Lack of caregiver hand and client foot washing ■ Routinely soaking feet prior to FC ■ Inaccessible FC - can’t get it


IPC and Reprocessing■ Spaulding Classification of Medical

Instruments & Required Reprocessing ■ Note: The ‘intended’ use of an instrument

determines it’s classification and the required level of processing.

■ Note: All re-usable items are cleaned before disinfecting or sterilizing.

■ Critical ■ Semi-critical ■ Non-critical


Critical Device■ device or instrument is intended to enter

normally sterile tissue or vascular system ■ must be sterile to the point of use (all

microbes killed) ■ examples include instruments used for

brain, kidney, heart and foot surgery


Semi-critical Device■ device or instrument intended to be in contact

with mucus membrane or non-intact skin and does not ordinarily penetrate sterile tissue

■ requires at least high-level disinfection (destroys mycobacterium, small/nonlipid virus, medium/lipid virus, fungal spores, some bacterial spores)

■ examples include endoscopes, laryngoscopes, some respiratory therapy equipment, cystoscopes


Non-critical Device■ device or instrument that doesn’t usually

touch client or only contacts intact skin ■ needs low-level disinfection and sometimes

only cleaning ■ examples include BP cuffs, stethoscopes,

environmental surfaces


What About FC Instruments?■ Used with different intentions for various foot

care providers ■ One classification does not fit all instruments ■ Would not expect instruments used for

podiatry surgery to be classified the same as a set of nail clippers used to trim someone’s toenails

■ BC PICNet Working Group very helpful


BC PICNet Working Group■ Reprocessing of Equipment and Instruments Used in the

Provision of Foot Care (March, 2015) Discussion Paper ■ “significant differences in opinion” “lack of evidence”

“creates difficulty” in finding consensus ■ Objective: review current evidence associated with foot

care equipment and infections, other guidelines and standards in use, and develop recommendations that have fully considered the evidence and risk to patients from reusable equipment used to provide foot care.

■ Recommendations: Although would technically be classified as non-critical; prudent to consider instruments for noninvasive FC as semi-critical bc of some clients who are higher risk


FC Instruments Semi-critical“It is recommended that metal files, corn and callus rasps, nail nippers/cutters, scissors, probes, curettes, and rotary tool burr (if not disposable) be reprocessed as though they are semi-critical if they are used for multiple clients. Although the intended use of these instruments brings them in to the non-critical classification, the group agreed that increased prudence was advisable in recognition of the underlying health conditions of many people who require foot care services, and the risk of exposure to non-intact skin should an unintentional nick occur. Semi-critical instruments require cleaning followed by high level disinfection.”

(Reprocessing of Equipment and Instruments Used in the Provision of Foot Care , PICNet, March, 2015)


Classification of FC Instruments■ Reminder: intended use determines the

classification, not errors in assessment, care or reprocessing

■ Podiatric surgery: critical ■ Noninvasive Nsg FC: semi-critical ■ BFC: semi-critical ■ Dedicated sets: non-critical


Non-invasive Nsg FC - Reprocessing■ Containment ■ PPE / OHS ■ Preparation of Environment(s) ■ Cleaning and high-level disinfection ■ Chemosterilization - PREempt CS20 (7% AHP)

used by most FC Nurses in NS ■ Autoclave and out-sourcing options - some

nurses prefer heat (convenient or facility policy) ■ Storage ■ Reprocessing Log (in/out, exp, testing)


Policy & Procedure Development■ Necessary to have - update prn ■ For foot care, IPC, documentation, external

care providers, communication, roles of team members …

■ Detailed explanation of what is done and why and by whom (concise and specific)

■ Foot Care NS example available prn (? posted to NS IPAC website or email Alison Petten RN or Michelle Petitpas LPN to request)


Tips for Continuing Care Leaders■ BFC for all clients; low and high risk ■ Diabetes isn’t the only thing that makes

someone higher risk ■ FC requires teamwork and communication ■ Communication; verbal + written ■ FC Nurse on staff - resource role ■ FC Nurse external care provider - some

considerations next slide


FC Nurse as External Care Provider■ Discuss, explore, agree, document regarding

■ access to health records (internal + FC) ■ process for communicating with staff ■ consent ■ incident reporting ■ follow up ■ what IPC measures ■ how stay current and maintain competence ■ other considerations


Questions?


Q & A■ How is FC regulated? ■ Is Scope of Practice noninvasive for all

nurses? ■ Why do some FC Nurses and others

insist on ‘sterile to the point of use’ and steam autoclaves?

■ Why not routinely soak feet prior to? ■ Your 3 most important messages today?


Thank you■ Please feel free to contact me directly for an electronic

copy of ‘Reprocessing of Equipment and Instruments Used in the Provision of Foot Care’ (PICNet, March, 2015) [email protected]

■ Michelle Petitpas LPN, Chair of NS FC Nurses Interest Group [email protected]

■ ‘Feet First … Delivering Safe Foot Care’ slides, ‘Advanced and Diabetic Nsg Foot Care’ course content and P&P for FC Instrument Reprocessing to be posted on NS IPAC website

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feet first- delivering safe foot care key first... · 2018-10-23 · basic (bfc) vs advanced (afc)...

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