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Reducing Diabetic Amputations: What Wound Care Teams Can Do

Now more than ever, those who specialize in treating wounds are in a position to make a difference. With diabetes and other chronic diseases on the rise, wound care services are in demand. Knowledge in the area is growing. Today, practitioners know a lot about helping at-risk patients avoid the most serious consequences of wounds.

This is certainly true of diabetic ulcers. While these wounds are all too common, there’s usually no reason for them to become debilitating. With the right guidance, diabetic patients can take practical steps to prevent them from worsening.

That said, deep infections aren’t nearly as rare as they should be. Despite many the advances made in the field, an infection can still lead to amputation. And to many diabetics, this is one of the worst outcomes imaginable.

In Ontario, what can the medical community do to reduce amputation rates? And what role should wound care specialists play? In this post, we’ll take a closer look at this persistent issue—and it’s potential solutions.

An Ounce of Prevention…

Medical amputations aren’t something most people think about. At a time when health care technology is developing rapidly, it’s easy to believe such drastic measures are no longer taken. Of course, wound care practitioners know better.

According to the Registered Nurses Association of Ontario (RNAO), an estimated 2000 Ontarians underwent lower limb amputation last year. It’s safe to assume that most of these patients were diabetics. After all, people with diabetes experience this type of amputation at 20 times the rate of those without the disease.

This brings us to what is, perhaps, the most shocking statistic of all. The RNAO reports that 85% of amputations are preventable.

In many cases, diabetes-related wounds can be treated effectively—even in patients’ homes. As disease rates skyrocket, health care leaders are searching for practical ways to prevent the needless suffering associated with infection. Stopping the progression of wounds is, of course, key.

Unfortunately, there are times when wounds are just too advanced for treatment. If you work with people who have diabetes, you know that one of its crueler aspects is how it can fool ailing patients into believing nothing is wrong. Diabetic neuropathy often prevents ulcer sufferers from feeling pain. As a result, they often fail to seek the help that they need.

By the time a patient with a deep or heavily-infected wound receives medical help, amputation may be the only solution. For the Ontario health care system, this is no small matter. On average, an amputation costs a whopping $74,000 to carry out.

For wound care specialists, it’s about more than just the monetary costs. Experts are aware of the pain and suffering that wounds can cause—and what can happen when they’re left too long.

A Multidisciplinary Approach

When it comes to preventing amputations, it’s important to treat diabetic wounds as early as possible. But what should treatment look like? Perhaps unsurprisingly, research shows that a team approach is often best.

Among wound care professionals, the benefits of holistic healing are well known. Patients with serious wounds often struggle with psychological pain, as well as physical. They may experience feelings of shame and depression. Some may receive a major boost to the immune system from proper nutrition—others, less so.

It’s easy to see how a range of health care experts—occupational therapists, dieticians, social workers, pharmacists—can promote healing. When these services are paired with advanced wound treatment, better outcomes follow. A reduction in ulcer-related amputations is one of the most obvious.

Just how much of a difference can a comprehensive approach when it comes to amputations?

As just one example, after implementing a multidisciplinary Limb Preservation Service, Madigan Army Medical Centre (Tacoma, WA) saw an 82% drop in lower-limb amputations.

There’s no doubt that supporting areas such as general immune function and mental health can help prevent wound complications. But when a foot or leg ulcer is present, treating the area directly is almost always the most crucial task.

The value of frequent monitoring and a rigorous treatment protocol can not be overstated. From wound debridement to granulation promotion, there are some functions that only an enterostomal therapy (ET) nurse is qualified for.

As part of a multidisciplinary team, ET nurses can help provide diabetic patients with wounds the best possible chance to maintain a high quality of life. Avoiding amputation is one of the most fundamental goals. But as teams members work toward their shared goals, how can they ensure they’re working together efficiently?

Integrating Wound Care Expertise

Intensive wound care follow up is incredibly important if patients are to avoid infection and other complications. But that doesn’t mean they need to spend all of their time in the offices of specialists. When it comes to diabetes, at-home management often works best.

But can home care really be proactive and multidisciplinary? When the stakes are high—as high as the potential loss of a limb—should preventative measures and ongoing monitoring really occur at home?

With the right infrastructure and planning, diabetes-related wounds can be cared for in patients’ homes. If you work in the home care sector, you already know this. But you also know that home care comes with its own special challenges.

In general, travelling can create difficulties for members of multidisciplinary teams—as can accessing up-to-date patient information.

The province is in desperate need of more wound care specialists. Unfortunately, because they’re in such high demand, these experts can’t always see as many patients as they’d like.

With diabetes, there’s always the risk that delayed or infrequent home visits could lead to oversight. Patients, after all, can’t always feel the pain of a wound. And a wound that goes unnoticed is at risk of infection—and, in some cases, at risk of causing an amputation.

With regard to home care, it’s also worth noting that amputation rates vary from one region to the next. In many Northern Ontario communities, for example, they’re very high. Diabetes impacts Indigenous communities disproportionately. And in remote areas, access to specialized care is limited.

The answers lie in advanced communication technologies. Mobile apps have never been safer or easier for multidisciplinary care teams to use. Doctors, specialists (including ET nurses), patients, family caregivers—everyone with a circle of care can now connect over long distances.

From real-time videoconferencing to secure information sharing, the future of home care has arrived. Properly harnessed, this technology might just be a future that’s free of diabetic amputations.

Making a Difference

Diabetes experts and wound care specialists will play a significant role in reducing amputations in the years ahead. It’s true that Canadian governments are working to combat diabetes. And in Ontario, home care services—which can be of great assistance to many people living with the disease—has become a major priority.

That said, advocating for a high quality of life for all diabetics is important. Part of this advocacy should include calling attention to the startling number of amputations that occur in this country.

But highlighting the issues isn’t enough. For health agencies and authorities, as well as individual practitioners, finding new ways to deliver high-quality wound care is key. Innovation and the willingness to harness it will be one of the biggest factors determining success.

Feature image courtesy of University of Liverpool Faculty of Health & Life Sciences’s photostream

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