Nicole has a Bachelor’s Degree in Podiatric Medicine from the University of Western Australia (Perth, Australia). She began her career as a Graduate Podiatrist at Sir Charles Gairdner Hospital – one of Australia’s leading teaching tertiary hospitals. In this role she had the opportunity to deliver education session to patients with diabetes and their families.

She quickly realised how passionate she was about the importance of providing education and delivering preventative healthcare initiatives. Since relocating to London, she has specialised in the management of Diabetic Lower Limb pathology and has vast experience working across multiple trusts.

She is a strong advocate for multidisciplinary working, and has helped to establish MDT clinics. She is also passionate about research and is fortunate to have had opportunities to undertake and present research. She has been working as a clinical fellow at NHS Resolution, where she has reviewed clinical negligence claims involving patients with diabetes and lower limb complications. She is excited and grateful for the opportunity to discuss the findings and recommendations from this work.

Presentation at The Society of Tissue Viability 2022 Conference

Diabetes and lower limb complications: a thematic review of clinical negligence claims

Objectives

After attending this session, persons will be able to:

• Understand the role of NHS Resolution’s Safety and Learning Team
• Understand how learning can be extracted from clinical negligence claims to guide improvements
• Understand the key recurrent themes in the claims reviewed relating to diabetes and lower limb complications
• Take the learning from the claims and consider how similar issues could be addressed locally
• Have an appreciation that diabetes and lower limb complications have huge impact of patient’s lives, and a MDT approach is required to help reduce the burden of this disease on patients and the healthcare system

Abstract

NHS Resolution have undertaken a thematic review of clinical negligence claims involving patients who have diabetes and a lower limb complication. A report has been completed detailing the recurrent clinical themes within the claims, as well as proposed recommendations.

The claims reviewed included analysis of themes across different aspects of the care pathway, from preventative care, management of diabetes foot disease, pathways between primary care and secondary services, admission into and discharge from hospital, management of peripheral arterial disease and education and psychological support.

Amongst the clinical findings several common themes were apparent at every stage of the patient journey including:

• A lack of thorough, evidence-based assessment
• Poor documentation and inconsistent terminology
• Absence of integrated multi-disciplinary care despite multiple disciplines being involved
• Changes to the patient’s clinical picture not prompting change in management plan or escalation
• Lack of recognition of peripheral neuropathy or consideration as to the influence this may have on clinical presentation

Overall, the recurring pattern among the claims were as follows:

• The severity of the pathology was not recognised
• The care that followed was not delivered with any urgency.

Several recommendation have been made, which are centred on the principles of:

• improved delivery of education to clinicians and patients
• standardised provision of diabetic footcare services
• clarity in the guidance to ensure pathologies and situations are identified consistently