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Testing for Diabetic Pts in Private Practice??

Discussion in 'Diabetic Foot & Wound Management' started by OneFoot, Oct 14, 2011.

  1. OneFoot

    OneFoot Active Member


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    Hi,

    Just wondering what testing you guys do on your diabetic patients in private practice??

    Ours (standard NVA stuff really)...

    Monofilament
    Vibration (Tuning fork)
    Neurotip
    Doppler - (Pedal Pulses)
    Muscle Strength
    History type questing (ie smoking, etc)

    What bothers me is.... most of the type a practice nurse has done all of the above... I kinda wish there was something that us 'only' Pods could do??

    Just want to be special :p

    Cheers
     
  2. Jacqui Walker

    Jacqui Walker Active Member

    I rent a room in a GP surgery, and my experience is that the practice nurse will probably check blood sugar levels, and when testing only use monofilament and tuning fork, they leave the doppler for when assessing for compression stockings, and the ones I know (up until I told them), didn't know that the neurotip fitted into the neuropen, and they were left in the drawer! So keep on doing what you're doing, I find that by explaining what I'm doing and why to the patients, gives them a lot of information that they've never been given before, makes them feel as if you've spent time with them which leads to better patient satisfaction, and also helps when it comes to footcare/footwear advice.
     
  3. OneFoot

    OneFoot Active Member

    true good point..
     
  4. Jonix

    Jonix Active Member

    Bit out of date, but I was trawling...

    In addition, I do past history of ulcer, subjective skin and condition, any lesions, and in particular, I assign a current risk status.

    A few diabetic patients get through the net, but on the whole, I tell them that if they want to see me regularly, they need the tests done by me!
     
  5. sarahhemsley

    sarahhemsley Member

    At our practice we do a an involved diabetes assessment with a recommendation and result section to wrap up our findings. In conclusion, like Jonix, we give the GP a risk assessment for neuropathic or vascular ulceration.

    It not only 'showcases' what service we provide at the practice but over time I feel GP's have felt comfortable relying on our assessment before using their nurses. ( With no disrespect to the nurses skills) .

    I would be happy to email you a template of our assessment but I think developing a good assessment with clear interpretation of your findings as well as recommendations will be your best selling point! The work for diabetes assessments will start rolling in!
     
  6. Zac

    Zac Active Member

    Do you routinely do a vascular & neuro assessment on EVERY new patient no matter what they are presenting for? I have been very politely challenged by another Pod that they do a vascular/neuro assessment on everyone including people presenting with clearly a mechanical related problem, as they are finding more & more people (even into their 20's & 30's) presenting with neurological deficits related to increased alcohol consumption in younger people. Any comments & should I be doing a neuro assessment on EVERYONE?
     
  7. Jonix

    Jonix Active Member

    I can't answer what you should be doing, but in my case, no. I just do it if there is a reason in their history or presentation. The neuro/vascular tests take about 15 min and I book them on a separate appointment. At one time, showing off my equipment maybe, I used to print off Doppler routinely on every new patient, but quite a few got irritated that I wasn't addressing their real issue.

    I would be interested to see if anyone else does routine neuro-vascular assessment.
     
  8. sarahhemsley

    sarahhemsley Member

    I also don't do a neur/vascular on every patient. I would politely state back to the podiatrist who suggested it to you, that this simply wouldn't be necessary for every new patient and very time consuming as well.
     
  9. Zac

    Zac Active Member

    Thanks for your reply Sarah. I lean towards your thoughts but the other Pod (who works extensively with people with diabetes) is seeing an increasing number of younger people (30-40 year olds) with neuropathic changes (that are either not diabetic or undiagnosed diabetic) again possibly related to increased alcohol consumption.
     
  10. Jonix

    Jonix Active Member

    Zac, I assume you are routinely checking. What are your observations regarding frequency of neuropathic changes, what is most common aspect of the neuropathy, and what do you do when you find an abnormality?
     
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