High-Risk Feet: What Support Workers Can Notice and Report

This campaign's first article introduced you to the day-to-day aspects of this campaign, this one explores the value of the most important part, the observation. For high-risk feet, the eyes of the support worker are performing a role that a clinical system cannot, namely, monitoring a body part that the patient is unlikely to see, feel, or judge.

The patient who feels no pain when the stone is in the shoe, who does not feel the blister forming, who does not feel the heat of early infection, has a clinical safety net that conducts reviews at the interval of the booking system, called scheduled reviews, and little else that catches deterioration. The person who helps with the socks in the morning looks at the feet every day, but the question is whether anybody has explained to them what looking is.

The watch-list, in plain language

Redness that doesn't go away when pressure is removed, any skin defect no matter how small, swelling especially in one foot, change in colour (paleness, blueness, darkness), any area of heat or discharge (or any new smell), a wound that doesn't visibly improve, patient complaint of new pain, tingling or numbness, blood or fluid marks within shoes or socks, wear patterns that have changed. All of the items on the list are reported same-day items, not to be judged, and every item on the list is accompanied by a one-line reason the library attaches to it: on a high-risk foot, small kindnesses cause large harms.

Reporting that reaches the clinic

This becomes a surveillance observation when it lands, and the foot version of this library's reporting system is quite simple: one number that answers, same-day rule for the list, a photo when the arrangement and consent are there, a telephone call when it's about nothing, and the standing culture stated in the brief. At the end of the clinic, it's the other habit that also completes the circle: the report acknowledged, the action noted back to the worker, as reporters who never learn what their report did, here too, stop reporting.

How this plays out in practice

Imagine a diabetic man with dense neuropathy, good foot care every six weeks in clinic and a simple glance at his feet every day by a worker who was never briefed. The unbriefed year is the well-known one that features the sock stain no one weighed, the limp blamed on old age, the ulcer shown at week five of its life, the months of wound care afterwards. The same roster, the watch-list on the fridge, the same-day call regarding a coin of redness on the ball of the right foot, the photo, the appointment brought forward, the pressure area offloaded before it opened, the briefed year is different. It took the worker 15 minutes to train. The only unit this population really cares about in the world of podiatry is tissue kept, and that is where the difference lies.

Next steps

Create the plain language watch-list as a template and place it on each of the high risk patient's support brief. If the briefing time for workers is 15 minutes per patient, the surveillance interval is daily.