My name is Jayne Robbie and I am a podiatrist (with a special interest in diabetes) working within a multi-professional hospital team treating people with foot complications associated with diabetes. My main aim is to reduce ulcerations and amputations which are the main cause of hospital admissions for diabetes in the UK.

I have worked in foot disease in diabetes for the majority of my career and am passionate about the unique role of podiatrists in contributing to improving patient care and outcomes.  But I can’t do it on my own we need to address the delays for people with foot problems accessing specialist services.  We can do this by raising awareness of the seriousness of foot problems and this is where ACT NOW comes in.

The acronym, ACT NOW (accident; change; temperature; new pain; oozing; wound) was devised by the iDEAL (Insights for Diabetes Excellence, Access and Learning) group in 2019. We are a multi-professional panel of experts, who along with the direct input from a person with diabetes, aimed to help people with diabetes recognise the warning signs, which may result in amputation, and to give them confidence to seek specialist care (1).  ACT NOW is designed to be practical and simple to use for anyone regardless of type of diabetes, education, language, or culture.  It is an innovative and inclusive tool that will realistically reduce healthcare inequalities and improve outcomes for vulnerable people by the utilisation of the 6-point checklist which comprises the ACT NOW acronym (see Figure 1). It can be downloaded and used free-of-charge, with no special training and without licence, and clearly demonstrates a commitment to the delivery of education as a fundamental aspect of improving clinical care and outcomes for people with diabetes, their carers or health care professionals.

Figure 1; the ACT NOW checklist – designed for use by all people with diabetes, their carers or health care professionals to determine if a foot problem requires referral to a specialist. This can also be printed off and used as the referral document to the specialist.

The resources have undergone several iterations before this final version has been developed for all people with a foot problem (see Figure 2), and the inclusion of the infographics mean that it is suitable for those with mental health problems or learning difficulties, as well as dementia and those for whom English is their second language, and so to enable people with diabetes, their carers or healthcare professionals with the tools and confidence to ACT NOW, (2).

Figure 2; infographic, aimed to be carried by patient or used as aide-memoir to remind of the ACT NOW acronym

As a result of this and our passion and commitment to person-centred diabetes care and education ACT NOW aims to;

• Increase the awareness of the risks to all people living with diabetes to promote foot health and avoid delays in seeking help when facing any difficulties.
• Establish a national education programme with practical information in an illustrated practical handout for all people with diabetes about foot self-care and checks from diagnosis onwards.
• Increase access to education in foot assessment and urgent referral for ALL Health Care Professionals working with people with diabetes.

The ACT NOW foot education resource has received widespread national recognition, being cited in National Woundcare Strategy guidelines, and achieved international endorsement via D-foot International and the International Diabetes Federation in 2020.  It was awarded the Diabetes UK Nursing and Allied Health Professionals Research Poster Award at the professional conference in 2021, as well as being widely published and presented. The innovative and practical ‘one-stop’ multi-professional nature of the ACT NOW resources will upskill and empower people with diabetes and healthcare professionals, thereby facilitating timely onward referrals and reducing the unacceptably high numbers of amputations. The importance of multi-professional working and robust care pathways ensures that all people with diabetes foot problems have access to the right medical interventions at the optimum time.  Early referral to specialist care reduces both hospital admissions and amputation rates.

The consistent and widespread use of the ACT NOW resources provides.

1. vital education and knowledge translation for healthcare staff to carry out routine foot examinations
2. a clear pathway for assessment if someone has new, worsening or re-occurring foot ulcers
3. a clear pathway for referral into a specialist foot protection service if someone is assessed as being at risk of foot ulceration

Improved foot care knowledge, assessment and urgent referral with practical education is essential, and the ACT NOW resources provide resilient safety netting for high-risk people by reducing delays, which may result in poor morbidity outcomes (in terms of ulcer healing and amputations) for vulnerable people. The adoption and regular use of the ACT NOW checklist can keep a focus on the vital nature of assessment, knowledge, and awareness to expedite timely referral to not only save limbs but ultimately to save lives (3).

If you would like to adopt any of the ACT NOW resources please download from www.idealdiabetes.co.uk and I can be found on Twitter at @darciedot

References;

1. Edmonds M, Phillips A, Grumitt J et al. ACT NOW! diabetes and foot care assessment and referral. 2019. 7918-IDEAL-Diabetes-and-Foot-Care_web4.pdf (idealdiabetes.com) (accessed 7/6/22)
2. Robbie J. Managing foot care for people with diabetes. Pract Nurs. Current Issues Diabetes Care. 2021;32(Sup3):S3–7. https://doi.org/10.12968/pnur.2021.32.Sup3.S3
3. Phillips A, Edmonds M, Holmes P et al. ACT NOW in diabetes and foot assessments: an essential service. Pract Nurs. 2020; 31(12):516–519. https://doi.org/10.12968/pnur.2020.31.12.516