Footing the bill

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					      Wound care

Footing the bill
Nursing homes increasingly are seeing and treating diabetic
foot ulcers. Managing and preventing them are paramount

                                                                                                                 can take someone from an ambula-          high blood sugar can reduce blood
                                                                                                                 tory setting, such as assisted living,    flow to the lower extremities, espe-
                                                                                                                 to the hospital and even to the grave     cially the feet.”
                                                                                                                 very quickly,” notes wound care spe-         Another relatively common short-
                                                                                                                 cialist Cynthia Fleck, RN, BSN,           coming in the skilled nursing setting
                                                                                                                 ET/WOCN, president of the                 is caregivers’ ability to effectively dif-
                                                                                                                 American Academy of Wound                 ferentiate between diabetic wounds
                                                                                                                 Management and vice president of          and pressure ulcers.
                                                                                                                 clinical marketing for Medline               Diabetic ulcers tend to occur
                                                                                                                 Advanced Skin and Wound Care.             below the ankle and typically on the
                                                                                                                   The financial impact of diabetic        plantar aspect of the foot, over the
                                                                                                                 wounds is equally sobering, costing       metatarsal heads and under the heel,
                                                                                                                 facilities upward of $10,000 per          according to Fleck. “Think of it in
                                                                                                                 episode to treat—and far more if the      terms of where the rubber meets the
                                                                                                                 wound leads to an amputation. The         road and where the toe hits the toe
                                                                                                                 good news is 90% of amputations           box with every step.”
                                                                                                                 are preventable, and many times, the         Although pressure indeed plays a
                                                                                                                 wounds themselves are, as well.           role in both types of wounds,
                                                                                                                   “The bad news is some [providers]       experts agree that caregivers who
                                                                                                                 aren’t doing what’s necessary to drive    aren’t able to make the distinction
                                                                                                                 positive outcomes in elderly diabet-      could very well be missing the
                                                                                                                 ics,” explains David G. Armstrong,        opportunity to address the diabetes
                                                                                                                 DPM, Ph.D., professor of surgery at       itself and prevent future wounds
                                                                                                                 the University of Arizona College of      and diabetes-related complications.
                                                                                           Photos: iStockphoto

                                                                                                                 Medicine in Tucson.                          “It’s important to recognize that a
                                                                                                                                                           diabetic wound is a symptom of a
                                                                                                                 Bridging the gaps                         greater problem. While it’s obviously
                                                                                                                 Numerous factors contribute to            important to manage and heal the
Amputation is a worst-case result of a diabetic foot ulcer. The good news is that 90% of                         inappropriate or insufficient diabetic    wound, it’s imperative that the under-
amputations are preventable, and many times the wounds themselves are too.                                       wound management. For starters, as        lying cause of that wound is properly
                                                                                                                 many as half of all diabetics are undi-   and consistently addressed,” says
BY JULIE E. WILLIAMSON                          betic elders who develop a foot ulcer                            agnosed, and because the elderly          geriatrician Jamehl Demons, MD,
      oughly 8.6 million Americans              also succumb to a subsequent bone                                often have other medical conditions       assistant professor, department of

R     over age 60 are diabetic and
      up to 15% of them develop-
ing a diabetic foot ulcer. Knowing
                                                infection. In addition, as many as
                                                25% of those with infected diabetic
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