Foot CPR: Patient-Centered, Integrating Multiple Support from Caregivers and Medical Teams

Bundle care
(Patient-centered, multi-professional collaboration, and caregiver-oriented care principles)

The care of Diabetic Foot Ulcers (DFUs) requires multi-professional collaboration to address the comprehensive care plan for patients' multiple needs. This includes regular checks of ulcers by medical personnel or trained caregivers1,2, a holistic assessment of the patient's condition, and timely medical consultation or referral to other specialties.

Enhancing Patient Self-Awareness

Early detection and seeking medical assistance are crucial for preventing wound deterioration. Many DFU patients tend to underestimate the severity of their ulcers (especially when numbness may significantly reduce the sensation of pain) or expect wounds to heal on their own and failure to seek medical assistance in time. This could lead to significant deterioration of the wound or a delay in seeking medical care until prompted by family members, which can greatly affect the patient's prognosis3.

Foot CPR: Check, Protect, Refer2：

Foot CPR (Check, Protect, Refer) is a simple and effective assessment method. It quickly assesses the patient's condition and provides foot protection when necessary while considering medical consultation or referral to other specialties based on the patient's situation.

1. Check

"Self-Testing: A Home Inspection Guide for Diabetes Foot Symptoms"

Has the patient had a history of DFU?
Is there a current presence of an ulcer wound?
Suspected peripheral neuropathy, peripheral arterial disease4？

2. Protect

"The Power of Self-Care for Feet: Practical Tips to Prevent DFU"

If any of the above checks are answered 'yes', or if the patient is currently bedridden, then appropriate offloading foot protection should be provided.

3. Refer

If the patient has any of the following conditions, they should seek medical attention or be referred to other specialties promptly：

Foot ulcers
Gangrene
Other considerations

Comprehensive Evaluation and Personalized Treatment Plan

Comprehensive Evaluation and Personalized Treatment Plan2：

Blood sugar control, and insulin should be used if necessary.
Treat edema or malnutrition if needed.
Treat risk factors for cardiovascular disease.
Treat depression or other psychosocial distresses.

Multi-professional, Integrated Medical Team

In addition to wound care and infection experts, the care team should include medical personnel or caregivers with expertise in rehabilitation, psychology, and nutrition because DFUs significantly impact the patient's physical function, quality of life, and mental health, and many patients also have some degree of malnutrition4This multi-professional, integrated model of medical care can provide more comprehensive care and has been proven to reduce the recurrence rate of DFUs5.

The Role and Support of Caregivers6

Caregivers also play a key role in the treatment process of DFU. They need not only understanding DFU-related knowledge and providing the necessary support to patients, but also be involved in the multi-professional team to jointly promote the patient's overall health.

Chen P et al. Diabetes Metab Res Rev. 2023;e3644.
Schaper NC et al. Diabetes Metab Res Rev. 2023;e3657.
Coffey L et al. Int Wound J. 2019;16(1):183-210.
Armstrong DG et al. JAMA. 2023;330(1):62-75.
van Netten JJ et al. Diabetes Metab Res Rev. 2016;32 Suppl 1:84-98.
Suglo JN et al. J Diabetes Res. 2022;2022:9007813.