SCP 2010 ADA

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I see that Motion 21 of the SCP 2010 ADA, says that,

"many members are concerned that there are still practising podiatrists who are using the same instruments for all patients."

Now, how do people know this?!

With nursing/care/residential homes, should there not be a LEGAL requirement to have a log book of traceability to show which tray/instrument set was used on which patient. This would need to be audited 6 monthly?

 

Disgruntled

Firstly, how do other pods know that there are practitioners using the same instruments? I do not see how this could come to light unless they are spying or have been told ie second hand information. I really feel that this motion ha been motivated by an individuals concerns ie possibly a personal grudge rather than a general issue.

Insrument traceability for nursing homes? Why do you suggest this? Are there actually problems in nursing homes or is this a way of legislating above and beyond the actual risk factor for pods? In reality , many FHPs cover nursing homes with few problems-these are not high risk patients, the less mobile they become , the more routine their treatment.
Dont we have enough legal requirement to meet already?

Cornmerchant

 

CM,

This may be true but does that mean we should drop our standards for nursing/residential home? Surely we should have the same standards that we use for our other patients?

I would disagree with that as most have compromised circulation due to age/infirmity and a myriad of other problems either age-related or due to polyphamia. I agree that the less mobile they become the less likely they are to require chiropody treatment per se but they will still need a 6 monthly footcheck.

It all depends if they are staying at the home as 'residential' or 'nursing'. If they are residential clients then the nursing staff will have no imput and it is our responsibility to be vigilant.

I agree it is a strange motion to put forward to the ADA and wonder where the proof is for this assertion?

 

Catfoot

I am not suggesting dropping standards- just that we should accept that many of these patient have purely palliative needs ie nail cutting which seem to be within the boundaries of FHPs.
I am not sure where you get your evidence that they are more likely to be high risk?

Cornmerchant

 

Re: Nursing Home Clients

CM,
You ask

Whilst nowadays old age is not necessarily synoymous with infirmity, it would be true to say that most persons in Part 3 accomodation are both elderly and infirm. They will have medical and physical/mental health problems that render them incapable of independent living. Therefore, the incidence of conditions that place the foot 'at risk' will increase.
Those that are classed as 'residential' will be more at risk than those classed as 'nursing' because the first group will have no input from any medically-trained person.

One of the most common problem I have encountered with this client group is that all have reduced ambulatory capacity. The result of this is that many will spend much time seated with the lower limbs dependent causing the efficacy of the soleal pump to be compromised. The knock-on effect from this is venous pooling and stasis which impacts on tissue viability. These clients are at risk of developing gravitational eczema, oedema and venous ulcers.

If we accept these clients as patients, then we have a duty of care to them which necessitates a holistic approach with regular monitoring of the neurological and vascular status of the foot in addition to basic footcare. I believe this is what we spent 3 years training for - not to adopt the cut-and-come again approach of the unregulated.

They may not need much podiatry treatment per se, but we can use our skills to try and prevent systemic foot health problems before they occur.

CF

 

Catfoot
As far as I can see, this is your opinion, not actual hard facts.

Believe it or not, other care staff do actually notice swollen legs and eczema and venous ulcers and call the GP /nurse who can do something about it if they see fit. We as pods may have superb skills in diagnosing such conditions but we are helpless to do anything about them- it is not within our remit, and it is not alway the case that these conditions result in foot problems. Of course we are always vigilant, but actually, FHPs are probably very wary of these conditions as well because they know their limits and refer on for much lesser things, erring in fact on the side of caution.

Cornmerchant

 

why would anyone in their right mind use a set of instruments on more than one person? personally i would not want to take that risk with anyone, being old is not open season for poor standards, presumably these patients are paying privately or are recieving state care, they deserve the same care and attention that a baby ( or anyone else does)

 

CM,
Which part of my post would you say was non-factual?

Ed,
I am still curious to see where the proposers of this Motion get their information from.


CF

 

CF, i am not sure more legislation is the answer, perhaps better thought out, practical and measurable guidlines could be a solution. I adhere, to the best of my ability (no ones perfect) to the standards and guidelines of SOCAP and the HPC, but there is a raft of practitioners who are not regualted in this way. Would it not be better to have some sort of common guideline to encourage a level ( at least) of basic care. The cost of sterilising instruments is high and i am required to do this, but many practitioners are not, is this okay? I am not sure that it is. By the way I agree that nursing and care staff are, in general, caring and conscientious.

 

Catfoot
My apologies- my "hard facts" remark should read "clinical evidence", I can see how you misinterpretted it. I believe tht the scenarios you relate are indeed "factual" in your opinion, but where is the evidence that actually states that people in care are more at risk than those who are not in care? Who has published the studies?

Edward1so- SOCAP isnow SCP and has been for some time.

Regards
Cornmerchant

 

cornmerchant,
apologies, just an old fashioned girl
E1

 

CM,
You are correct when you say there there have been no studies done (to my knowledge) concerning the podiatry requirements and foot health status of those in Part 3 accomodation compared to those in Part 2 / Part 1 accomodation.

However, IMO, those in Part 3 accomodation are more At Risk because they will have more lower limb pathologies, more medical problems, and more complex drug regimes.

Is this our problem as Podiatrists? - IMO yes, if we adopt a holistic approach to patient care.

Can we do anything about these factors ?- apart from being vigilant and referring on where appropriate - no.

Can we make a difference to the patient's quality of life? - possibly, if there is timely intervention.

These are my opinions, you are, of course, free to differ.

I will always believe that if we take on this type of client then we owe them duty of care which includes regular foot assesements/monitoring. Unfortunately, many clients cannot or will not pay the appropriate fee for this comprehensive type of service. The residential homes also support the cheap "cut & come again" mentality. This is one reason why I have not accepted any residential home work for about 5 years.

One of my patients is a manager of a residential home. When I asked them why they did not engage the services of the person who visited the residents every 6 weeks their response was " oh they're OK for the residents but I want a proper Chiropodist".

CF

P.S. There is an interesting thread in the Australia Forum about Nursing Home Fees.