Diabetic Foot Ulcer Referral Tool - South West Regional Wound Care Program

The purpose of this tool, is to guide you, as a healthcare professional, in building your patients ‘dream team’, as it relates to their level of diabetic foot risk.

To use this tool you must have already assessed your patient’s feet using a validated diabetic foot screening tool such as the:

DIABETIC FOOT ULCER RISK STRATIFICATION & REFERRAL (FURST) ALGORITHM

Diabetic Foot Ulcer Tutorial Video

Have you completed a foot screen and determined your patient’s level of risk?

NO

Once you have completed your risk assessment and stratified your patient’s risk as either low, moderate or high (stratification depends on the assessment tool you used and its individual instructions), proceed to the “YES” area below.

Harmonized Risk Assessment Tool

YES

Great! You have used a valid diabetic foot screening tool and risk stratification system and have determined your patient’s level of diabetic foot risk (low, moderate or high). Using the dial below, please indicate your patient’s level of diabetic foot risk to proceed with building their diabetic foot ‘dream team’.

Low Risk Moderate Risk High Risk

Low Risk

Moderate Risk

High Risk

Low Risk

Persons with diabetes who are deemed “Low Risk” present as follows:

Diabetic Foot Ulcer Risk Stratification & Referral Algorithm risk category 0
Intact sensation (absence of sensory neuropathy) AND
Intact skin (absence of any current ulcerations and no history of diabetic foot ulcerations or foot amputations) AND
Adequate blood flow to the lower limbs
May or may not have a bony/structural foot deformity

Such people require:

Annual foot screening and risk stratification by a trained healthcare profession, i.e. you
Written and verbal education regarding foot care, foot wear and emergency contacts.You may print the educational materials below and provide/discuss them with your patient.You may also consider referring your patient to a diabetes self-management class, hosted by the South West Self-Management Program.

Diabetic Foot Ulcer pamphlet
PDF

Drop Your Socks pamphlet

Moderate Risk - Instructions for Building your Team

Persons with diabetes who are deemed “Moderate Risk” present as follows:

Diabetic Foot Ulcer Risk Stratification & Referral Algorithm risk category 1, 2a, 2b
Loss of protective sensation, absence of a bony/structural foot deformity, absence of peripheral arterial disease (PAD) and intact skin, OR
Loss of protective sensation PLUS a bony/structural foot deformity, absence of PAD and intact skin, OR
Presence of PAD and intact skin

Such people require:

Bi-tri annual foot screening and risk stratification by a trained healthcare profession, i.e. you
Written and verbal education regarding foot care, foot wear and emergency contacts.You may print the educational materials below and provide/discuss them with your patient.You may also consider referring your patient to a diabetes self-management class, hosted by the South West Self-Management Program.

Diabetic Foot Ulcer pamphlet
PDF

Drop Your Socks pamphlet

Assemble a “Moderate Risk Dream Team’ for your patient by choosing from the following community resources keeping in mind the essential components of:

An AHCP who specializes in diabetes
An AHCP who specializes in wound prevention, assessment and management
An AHCP who specializes in systems navigation

High Risk - Instructions for Building your Team

Persons with diabetes who are deemed “High Risk” present as follows:

Diabetic Foot Ulcer Risk Stratification & Referral Algorithm risk category 3a or 3b
Current or previous history of diabetic foot ulceration AND/OR
Previous history of amputation

Such people require:

Weekly-monthly foot screening by a trained healthcare profession, i.e. you
Written and verbal education regarding foot care, foot wear and emergency contacts.You may print the educational materials below and provide/discuss them with your patient.You may also consider referring your patient to a diabetes self-management class, hosted by the South West Self-Management Program.