foot check on diabetic at dialysis clinic

[Healerforlife]

So tonight I was doing a footcheck on a patient for the first time me doing it. He comes by stretcher for tx. he's 350 pound diabetic, who needs bilateral hip replacements, Lives at a nursing home. ANYWAY, his toenails were about an inch long on all his toes. I have not seen his shoes off before as another nurse was checking him. ( that's another story) What can I do about this? He says they haven't cut them since February, which, Um, is coming up. It's disgusting. He's diabetic!! How is this not neglect? Is there anything I can do to scare them into taking action? The nurse at the nursing home said "He's on the list" Not too encouraging. Thanks for any advice

[TheCommuter, BSN, RN]

This is very true...unless the nursing home resident is under the age of 65, which is becoming all too common in many facilities. Those under the age of 65 do not qualify for Medicare unless they can prove a permanent disability or have end-stage renal disease with chronic dialysis treatments.

I'm responding to my own quote because I had a senior moment...the patient with the long toenails in the OP certainly has Medicare by default because he is on the End-Stage Renal Disease program. My bad...carry on!

[SmilingBluEyes]

Our responsibility in dialysis is to do the checks, chart and report the findings and follow up---also to monitor changes as they occur. The onus is on the providers to seek treatment as appropriate. I would definitely report such findings to the primary nurse at the facility as well as the patient's nephrologist. It is NOT on us to to seek the treatment ourselves. Nor to secure lawyers.

[Jensmom7, BSN, RN]

I'm responding to my own quote because I had a senior moment...the patient with the long toenails in the OP certainly has Medicare by default because he is on the End-Stage Renal Disease program. My bad...carry on!

I meant to point that out to you but then had my own senior moment and forgot about it lol.

[nutella, MSN, RN]

Clearly there is a need for certified diabetic foor care nurses in several areas. My mother is diabetic and has a podiatrist but it is his MA who does the actual nail care which seems odd - would actually prefer a nurse certified in foot care although we both like the podiatrist and MA a lot.

Do any dialysis clinics have trained nurses or podiatrists do checks and care there (in an appropriate area)? I know Medicaid isn't that great but Medicare should cover it.

And maybe ltc facilities should pay one of their nurses to obtain the needed training so someone is available more often.

Heck I think it would make sense for LTC to also have WOC nurses too. But I know the real world rarely meets our ideals...

Well - you can not clip nails and file nails in an area that needs to be clean - after all you access catheter/central line or fistula. Also, there is no time for somebody to do foot care....

The check is just to make sure somebody looks at those feet and if appropriate makes a referral/calls the MD...

[nutella, MSN, RN]

I'm responding to my own quote because I had a senior moment...the patient with the long toenails in the OP certainly has Medicare by default because he is on the End-Stage Renal Disease program. My bad...carry on!

Not necessarily - Medicare does not kick in right away.....

[nutella, MSN, RN]

Come on - what do you mean??? You can not just make it happen?? lol

There is a lot of misconception out there regarding dialysis ...

[Nurse Leigh]

Well - you can not clip nails and file nails in an area that needs to be clean - after all you access catheter/central line or fistula. Also, there is no time for somebody to do foot care....

The check is just to make sure somebody looks at those feet and if appropriate makes a referral/calls the MD...

I specified that it would require a separate (appropriate) area. I just think it seems there needs to be more access to foot and nail care for diabetic patients.

[nutella, MSN, RN]

I specified that it would require a separate (appropriate) area. I just think it seems there needs to be more access to foot and nail care for diabetic patients.

Sure - access is needed - but not in a dialysis clinic...

[SmilingBluEyes]

Sooo you want me to risk cutting someone's toe in a clinic where germs and blood abound, and infect that toe....on a high risk diabetic patient?

Not likely.

[Nurse Leigh]

Sooo you want me to risk cutting someone's toe in a clinic where germs and blood abound, and infect that toe....on a high risk diabetic patient?

Not likely.

Did you understand where I said in a different area? And really my point is there needs to be more options. We want to prevent problems and wounds.

I also mentioned having it done on site in LTC.

[SmilingBluEyes]

Yes, I understood as I read your post.

There IS no different area and there IS no time for us to do this. And no real way to ensure we can do this in a manner that would ensure they would not get an infection.

You don't know how dialysis units work.

And your idea about doing foot care on-site in LTC is not new; that is already being done. It was at the LTC where I worked, where they lined up residents and the podiatrist and his nurse did exams, clipped toenails and did other foot care on the residents.

[Nurse Leigh]

Yes, I understood as I read your post.

There IS no different area and there IS no time for us to do this. And no real way to ensure we can do this in a manner that would ensure they would not get an infection.

You don't know how dialysis units work.

Please stop implying I am stupid - my whole first post was more of an "if only"

While I haven't worked dialysis my mother was on it for several years some I am actually not a completely ignorant idiot. Can you please take my post in the spirit in which it was meant? That it would be better if things were different?