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鈥楬appy Feet' at MGH means much more than tap dancing
Michael 九游体育's (MGH) 鈥淗appy Feet鈥� is a nursing-led program providing foot assessments and education to hemodialysis patients.
The name is inspired by the movie featuring a tap-dancing penguin, and is designed to 鈥済ive the assessments a more positive, fun vibe and help keep it on everyone's radar,鈥� says Cathy Scott, clinical specialist for renal care at MGH.
People with kidney disease are at a higher than average risks for foot problems and hemodialysis patients have very high rates of diabetes, putting them at even greater risk.
鈥淟imited vision, poor mobility and the fact that many of our patients are socio-economically challenged and unable to pay for foot care, also hinders their ability to manage their own feet,鈥� says Cathy, who has been a nurse since 1985. She returned to hemodialysis as a supervisor in early 2016 and is now a clinical specialist in the Kidney Care Clinic.
鈥淭he renal population is my passion and where I want to be. My husband has kidney disease and received a pre-emptive kidney transplant. He is now well, so I have both a personal and professional interest in this population. I am able to emphasize with the patients and their families as I have an understanding of what they are going through.鈥�
Simple idea has made a big difference to patients
The idea, while uncomplicated, places a high value on simply seeing everyone's feet once per month. The program has seen substantial results, including fewer incidents of wounds or ulcers and no amputations between 2015 and mid-2017, despite the fact that two patients were close to amputation when the program began.
It was the passion of one nurse, Gladys Palacol, who in early 2015 recognized the need and started working on a solution. When Cathy returned to the unit as supervisor, she and Joanne Breckles, pharmacist, were keen to support Gladys in championing the cause to make it sustainable.
Joanne and her student Sandy Liu, developed a foot assessment tool which was well received for its 鈥渟imple and visual鈥� nature. A nurse on modified duties was commissioned to do baseline foot assessments for all patients and then Cathy began in earnest to use the tools available to engage and get buy-in from the team. Huddles, weekly updates and one-on-one meetings helped to train nurses on how to use the tool. Monthly statistics showed the reduction of patient morbidities.
The nursing team was given free rein to work out the details of how and when to do the assessments, which are now a standard protocol during the last week of each month and part of the physician review.
鈥淗emodialysis nurses see the same patients three out of six days each week for years, thus developing strong relationships with them and their families,鈥� says Cathy. 鈥淪o, when statistics drove home the benefits for patients, the nurses really took this on, despite the extra work in their day. The entire hemodialysis nursing team performs the assessments now and recognizes the great benefits that have been realized.鈥�
Nurses found that foot assessments gave them one-on-one time with patients and a chance to educate them about proper foot care and footwear. They also work with the patient's friends and families so they are able to support their loved ones in developing and maintaining good practices.
The program continues to be a success because of the growing buy-in from patients.
鈥淢any who were nervous and uncomfortable about exposing their feet are now comfortable,鈥� says Cathy. The unit's Patient Experience Panel was consulted and issues that patients deemed important were implemented, including the installation of a What's on Today board which reminds patients when it's time for their foot assessment to be completed. Outcomes are also shared regularly in the unit's quarterly patient newsletter, 鈥淭he Dial鈥� to help keep patients engaged.
鈥淗appy Feet鈥�, a simple nursing-led intervention implemented by a small team at MGH has had profound results for hemodialysis patients at no extra cost to the healthcare system.