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Think diabetes.... think foot care!

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The ‘Think Diabetes… Think Foot care!’ poster and information leaflet project was developed to provide basic foot care and information for Health Care Assistants (HCAs) working in the residential care setting. HCAs do not always have awareness of, or access to basic knowledge around the importance of foot care for residents with diabetes.

Diabetes UK (2014) suggests 27% of those in residential care have diabetes. These residents represent a vulnerable patient group (Diabetes UK 2014). Prevalence of vascular complications is high, they are more vulnerable to wound related infections, hospital admissions are higher than in people living in their own homes (Diabetes UK 2014); they often require help and support to perform daily foot care regimes.

Locally, the number of older people is higher than the national average which is reflected in the high number of residential care homes. This provides challenges for the community health services in terms of providing education and training for significant numbers of carers on the complexities of diabetic foot care and ulceration.

The project’s vision was therefore to produce a basic education tool for HCAs that would enable them to develop their skills and knowledge around delivery of timely and appropriate foot care for residents with diabetes.


The project arose as an outcome of a serious incident investigation involving a resident in a care home with an infected diabetic foot ulcer. Missed opportunities for earlier intervention regarding their foot care were highlighted. A learning outcome was identified around training and awareness of diabetic foot care for HCAs working in this setting.

Three main project aims were identified. These were to raise awareness of, and address gaps in HCAs’ understanding of basic

diabetic foot care, to promote and ensure a consistent approach for diabetic foot care for residents and to highlight referral pathways to wider multidisciplinary teams.

A brief literature search identified numerous National Standards and initiatives aimed at improving diabetes care for those in residential care (Diabetes UK); there was however, a paucity of information specifically on diabetic foot care aimed at care staff.

A robust implementation strategy was developed. Support from partner organisations was secured.


The poster and leaflet were designed to be short, concise and easily accessible for carers. It included different sections, each pitched at appropriate level for staff who may have limited knowledge on the potential complications and consequences of diabetic foot ulceration. More detailed information would not necessarily be appropriate for untrained carers.

The poster contains a structured referral pathway complete with timescales for onward referral depending on the presentation of a resident’s foot. This was vital information given the evidence showing that morbidity and mortality increases as a result of delays in diagnosis and treatment (Turns 2015).


HCAs working in residential settings are often a difficult to engage with in relation to training. If Community nurses are not involved with residents in a particular home, access to HCAs is further reduced. This means that identifying gaps in knowledge around diabetic foot care is often challenging and even more difficult given the high numbers of care homes locally. Strategies to address this are however important given the documented implications of diabetic foot ulceration and the impact this has not only on the patient’s quality of life but also on the health economy (Turns 2015; Kerr 2012).

It is hoped the project will have a positive impact on patient care, well-being, safety and the health economy. This can be achieved by empowering carers to deliver appropriate, effective and timely care to some of their most vulnerable residents by providing them with the information and skills needed to do so.


The development of the poster and leaflet is an exciting and innovative project. The literature review highlighted the lack of information available for carers working in residential care homes.

This initiative fills the information gap for carers by providing a resource that introduces the idea of caring for a residents feet. By doing so carers are enabled to develop an understanding of how to improve foot care for their residents with diabetes and directed to appropriate referral pathways. Importantly, the resource will promote a consistent approach to diabetic foot care across care homes locally. Given the high numbers of these in the Trust, the importance of this cannot be underestimated.


Diabetes UK (2014). Diabetes care for older people resident in care homes. www.diabetes.org.uk/Profesionals/Resource/Carers-of-older-people-with-di... Kerr. M. (2012). Foot care for people with diabetes. Fact sheet 37, NHS Diabetes; Turns, M. (2015). Prevention and Management of diabetic foot ulcer. Community Wound Care.

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