ACT NOW TO PROTECT YOUR FEET

My name is Jayne Robbie and I are a podiatrist (with a selected interest in diabetes) working on a multi-disciplinary hospital team treating individuals with diabetes-related foot complications. My primary aim is to scale back ulcers and amputations, that are the leading reason for hospital admission for diabetes within the UK.

I actually have been working in the sector of diabetic foot take care of most of my profession and am captivated with the unique role podiatrists play in helping to enhance patient care and outcomes. But I can not do it by myself. We’d like to tackle the delays in accessing specialist services for individuals with foot problems. We will achieve this by raising awareness of the seriousness of foot problems, and that is where ACT NOW comes into play.

The acronym ACT NOW (accident; change; temperature; latest pain; oozing; wound) was developed by the iDEAL (Insights for Diabetes Excellence, Access and Learning) group in 2019. We’re a multi-disciplinary panel of experts who, with direct support from the person with diabetes, , which is meant to assist individuals with diabetes recognize warning signs which will lead to amputation and provides them confidence that they’ll need specialized care (1). The ACT NOW app has been designed to be practical and straightforward to make use of for everybody, no matter diabetes type, education, language or culture. It’s an modern and inclusive tool that can realistically reduce health care inequalities and improve outcomes for vulnerable people through the use of a 6-point checklist that features the acronym ACT NOW (see Figure 1). It’s free to download and use, without special training or licensing, and clearly demonstrates a commitment to education as a fundamental aspect of improving clinical care and outcomes for individuals with diabetes, their caregivers or health care professionals.

Figure 1; ACT NOW checklist – designed to be utilized by all individuals with diabetes, their caregivers or health care professionals to find out whether a foot problem requires referral to a specialist. You can too print it and use it as a referral document to a specialist.

The resource went through several iterations before the ultimate version was developed for all individuals with foot problems (see Figure 2), and the inclusion of infographics means it’s suitable for individuals with mental health or learning difficulties, in addition to dementia and other people for whom English is a second language, to offer individuals with diabetes, their carers or healthcare employees with the tools and confidence to ACT NOW, (2).

Figure 2; infographic, intended to be worn by the patient or used as a helpful souvenir recalling the acronym ACT NOW

In consequence of our passion and commitment to person-centered diabetes care and education, ACT NOW’s goal is to:

• Raise awareness of the risks for all individuals with diabetes to advertise foot health and avoid delays in searching for help for any difficulties.
• Creation of a nationwide educational program containing practical information in an illustrated practical leaflet for all individuals with diabetes on self-care and control of their feet from the moment of diagnosis.
• Increasing access to foot assessment education and urgent referral for ALL healthcare professionals working with individuals with diabetes.

ACT NOW’s foot education resources have gained widespread national recognition, are cited in National Wound Care Strategy guidelines, and in 2020 gained international endorsement through D-foot International and the International Diabetes Federation. They were awarded the Diabetes UK Nursing and Allied Health Professionals Research Poster Award at an industry conference in 2021 and have been widely published and presented. The modern and practical, comprehensive, multidisciplinary nature of ACT NOW resources will upskill and empower individuals with diabetes and healthcare professionals, thereby facilitating timely referral for further treatment and reducing the unacceptably high variety of amputations. The importance of multiple specialists and robust care pathways ensures that every one individuals with diabetic foot problems have access to the precise medical interventions on the optimal time. Early referral to specialist care reduces each hospital admissions and amputation rates.

Ensures consistent and widespread use of ACT NOW resources.

1. crucial education and translation of information for medical staff in performing routine foot examinations
2. a transparent path to evaluate whether a patient has latest, worsening or recurrent foot ulcers
3. a transparent referral path to a specialist foot service if an individual is deemed to be liable to foot ulceration

Improved foot care knowledge, assessment and urgent referral with practice education are essential, and ACT NOW resources provide a powerful safety net for those at high risk, reducing delays that may end up in poor morbidity outcomes (by way of ulcer healing and amputation) in case of susceptible people. Adopting and frequently using the ACT NOW checklist can give attention to the essential nature of assessment, knowledge, and awareness to expedite timely referral to not only save limbs, but ultimately save lives (3).

For those who would love to make use of any of the ACT NOW resources, please download them from the web site www.idealdiabetes.co.uk and yow will discover me on Twitter at @darciedot

Bibliography;

1. Edmonds M, Phillips A, Grumitt J et al. ACT NOW! assessment and referral to a diabetes and foot care specialist. 2019. 7918-IDEAL-Diabetes-and-Foot-Care_web4.pdf (idealdiabetes.com) (accessed 7/6/22)
2. Robbie J. Managing foot take care of individuals with diabetes. Nurse Practitioner. Current problems Diabetes care. 2021;32(Sup3):S3–7. https://doi.org/10.12968/pnur.2021.32.Sup3.S3
3. Phillips A, Edmonds M, Holmes P et al. ACT NOW in diabetes and foot diagnostics: a vital service. Nurse Practitioner. 2020; 31(12):516–519. https://doi.org/10.12968/pnur.2020.31.12.516

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