The Canadian Diabetes Association estimates 288,000 Albertans live with diabetes, costing $1.3 billion per year (2015). According to Alberta Health Services (AHS), 391 lower-limb amputation procedures were performed in Alberta on patients with a diabetic foot ulcer in 2013–2014.
Michele Labbie, a nurse practitioner at the Stony Plain Westview Health Centre, is working to change these amputation stats by focusing on prevention. Her team provides wound care and diabetic foot complication management and education. They often deal with wounds that people have had for years, are recurrent, or are difficult to manage.
Diabetic patients feel pain less than the average person. If they get a rock in their shoe, glass in their foot or a sunburn on their feet, they likely won’t notice. And like most people, they don’t look at their feet on a regular basis.
But Labbie says this needs to become a part of their daily routine. “One patient didn’t notice a golf ball in his shoe. This can lead to a serious wound in a short time,” says Labbie. “Diabetic patients don’t have the luxury of taking their shoes off without inspecting their feet.”
She teaches patients to recognize the early signs of what may lead to a wound, such as footwear that rubs. Though these personal assessments seem minor, they can have tremendous outcomes for the patients and significantly reduce health-care costs.
A small wound can lead to the amputation of toes, feet and limbs. Research shows that as many as 85 per cent of lower limb amputations can be prevented through early screening for, and treatment of, diabetic foot ulcers.
“Our team is very passionate about preventing diabetic foot complications,” says Labbie. “Unfortunately, patients have to pay out of pocket for treatments such as offloading devices.”
The Canadian Diabetes Association reports 57 per cent of Canadians cannot adhere to prescribed treatment because of the out-of-pocket cost of medication, devices and supplies.
One of the preventative tools Labbie uses to manage diabetic foot ulcers is total contact casting. Unfortunately, the cost of the cast – about $120– is enough to deter many patients from trying it. “One patient had an ulcer on her foot for eight months, and made regular emergency room trips for antibiotics,” Labbie says. “We put her in the cast and the wound healed in nine days.”
Proactive treatments could prevent patients from multiple trips to the ER or amputation. The Registered Nurses’ Association of Ontario recently raised this issue with their government, and their health minister announced in May 2017 that the cost of offloading devices for diabetic feet will be covered by provincial health care.
Labbie says the savings and the quality of life improvements for patients and families would be invaluable if we did the same in Alberta. “I think my team gives our patients the best chance to avoid lower limb complication or amputation because of the education, support and early intervention we offer,” says Labbie.
“We strive to maintain ongoing, therapeutic relationships with high-risk patients so that there isn’t a delay if they need repeat care. We try to have a circle of care where we follow through from beginning to end with patients and engage their family physicians,” says Labbie.
Her team inspires patients to achieve the best outcomes by:
Labbie says her team is close-knit. “I have a really supportive management team who listens to and supports good ideas. If you put together a strong business case for my manager, she doesn’t dismiss it,” Labbie says. “She’s allowed me to do things I’ve really felt are important and that make a difference. If you have a management team who sees what you do as important, you can affect change.”
Labbie sees her nurse practitioner role as the hub of a wheel, as she connects patients with the right care provider to meet their needs. She might diagnose and investigate, but she also connects each patient with who they need to see next in a timely manner, such as an occupational therapist, a physician specialist or a mental health therapist. Labbie makes sure the health-care professionals involved in care create a plan together, rather than in silos.
Labbie says shared knowledge, improved knowledge translation and provinciallyaccepted guidelines would strongly benefit client outcomes. She sees value in a strategic clinical network dedicated to wound management. “What’s really needed is a provincial team committed to incorporating proactive prevention measures and education for patients. That kind of work takes funding and focused people,” Labbie says.
Labbie believes she has a responsibility to share her knowledge. Better education will lead to better wound management. “That’s why I’m excited to be teaching in MacEwan University’s wound management certificate course this year,” Labbie says. “I want to improve what health professionals know about wound management so they can manage complex wounds better. Educating other health professionals will sustain the benefits to the people we serve.”
“When I leave nursing, I want to leave a legacy: something that makes peoples’ lives better,” says Labbie.
By Crystal Komanchuk
Alberta Health Services: albertahealthservices.ca/assets/about/scn/ahs-scn-don-diabetic-foot-care.pdf
Canadian Diabetes Association: diabetes.ca/getmedia/5efbfb1b-6acd-4169-938d-59f24400e2cf/alberta-election-diabetes-stats.pdf.aspx
Alberta Health Services: albertahealthservices.ca/scns/Page10321.aspx
Registered Nurses’ Association of Ontario: rnao.ca/sites/rnao-ca/files/QP_Day_2017_-_Offloading_Devices_final_-_public.pdf
Registered Nurses’ Association of Ontario: ontwig.rnao.ca/newsletters/2017/05/09/update-health-minister-and-hqo-offloading-devices