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Just wondering what the situation is on district nurses debriding HK from foot ulcers? My understanding was that they can put dressings on foot ulcers but any debridement must be done by a pod - anyone know? Recently attended a diabetic Pt at home to debride and redress ulcer only to find the RDNS had already debrided it a few days prior, so there was little for me to do but redress it. I've also heard on many an occasion of nurses doing nail care in hospitals...... Any comments....??

Its within their scope of practice.

Ah, now I know....it seems so commonplace now, that I was starting to wonder ....thanks!! All we need to make sure of now is that some senior GPs refrain from attacking ulcers with scissors,as I've experienced when faced with the butchered end result !

Jos,
As you know a pedal ucler is most likely caused by abnormal forces at the site of the ulcer. You should tell the nurse or the physician about the probable etiology.
Tell them you can do something about that etiology and must start right away. What's the worse thing that could happen? The best thing is that the indolent ulcer might finally heal. Here in the US there are wound care nurses who literlly manage the entire care of patients with foot morbidity along with whatever other diseases the patient suffers. Comorbidity exists in most ulcer cases-such as diabetes, PVD, CA, etc. So a working relationship with nurses is a must.
It does take diplomacy. And assertiveness. In nursing homes, I write the orders for the patient which I think are proper. I debride the lesions. I found that when I allow physical therpay or nursing to handle pedal wound care, I might return at the 2 month routine care interval and find the wound unimproved.
Podiatry must not let the trades (pedorthists & orthotists) and professions (nurses, physical therapists, physician assistants, nurse practitioners) take over.

Tony Jagger

Thanks for the comment, but the actual debriding of the ulcer was my question. I certainly insisted on padding and supply spare pressure relief felt pads for use in between my visits (RDNS attends daily), which help enormously with healing the ulcer. RDNS here seem fixed on using foam type dressings (eg lyofoam or biatain) alone, which is not so handy for plantar ulcers .

Interesting question this one, and not a simple answer at all. I have a friend who is a Div 1 nurse and a registered Pod, she has heavily researched this issue, and I've made a few phone calls myself too. On the one hand apparently there is the "skin penetration act" which liscences a profession to penetrate human skin.....Pods are accepted, nurses are not apparently. When I rang the ANF they said a nurse has liability insurance for whatever they are trained to do. I asked who defines what they are trained to do and they said "not us". My friend the nurse tells me that she and thousands of other nurse have not been trained to use a scalpel on a person, which course in nursing does include this in the training? my friend the nurse says there is not one that does. My experience in the field is that lots of nurses are prepared to have a go at just about anything regardless of whether they have any specific training in something or not. The legal issues and liability issues are things that don't necessarily get considered beforehand and won't really be sorted out until some one gets sued. In my area there are Cert 4 foot carers, Div 2 nurses and Div 1 nurses all doing various forms of footcare for money, some self employed and some in various public health bodies.

The Victorian Pod Assoc when asked for a clear statement of policy in relation to the scope of practice of Footcare assisstants and a clear statement of the liability issues for the podiatrist working with or employing assisstants were only willing to tell me that they were working on it, but that they thought the podiatrist remained completely liable for anything an assisstant did when working with or for them: this is now a year ago. Everybody says that only Pods should be working on people with diabetes, but in my area the others will work on any body that offers to pay them, and at least two of them are using scalpels, trained or not. Clearly none of the bodies involved are actually motivated enough about it to clarify anything and the semi-qualifieds working on the borders are more than happy for it to stay that way, from a govt perspective it helps keep costs of service to the public down because the supply and demand formula is diluted by the unqualified opposition, who as far as I know don't use sterilized instruments, and don't have a variety of the costs that I have in order to provide the service.
In all a murky picture which most of the players are happy to leave that way.
regards Phill Carter

I was not aware that they were allowed to debride plantar wounds the DNS nurses.
In my new job I work closely with a wound nurse specialist who is certainly qualified to debride wounds however she had only lightly debrided such wounds before a podiatrist was available (me) and handed all debridement over to me when I started. The DNS which works under her leadership, supervision and advice on typically most cases and do not debride any foot ulcers as far as I am aware and the wound nurse specialist does not either now.

I have no problem with those that are trained to do this and are aware of the issues and using the correct equipment (as per phil) being involved but when there is a butchered result that you have to deal with in the end from a party that is not qualified but thought they would 'have a go' rather than being contacted first frustrates me.

I am quite happy to work as a team for the best result, not to the detriment of the patient!