Health professionals - DiabACT Report

Explanatory Notes for use with the diabACT Report

The diabACT Report has been developed by the ACT Diabetes Service to provide a concise, comprehensive summary of a clients diabetes health and education status. A diabACT Report will be generated and sent to the referring doctor and to the client on completion of an initial intervention being registered in diabACT and following a Periodic Diabetes Review.

These explanatory notes provide information about the definitions and methods used to obtain the results contained in the diabACT Report.

The diabACT Report consists of seven sections:

  • Personal Details
  • Method of Management
  • General Assessment
  • Nutrition Assessment
  • Diabetes Education Skills and Knowledge Assessment
  • Podiatry Assessment
  • Additional Comments

Personal details

This section contains basic information about the patient including Name, Address, DOB, Gender, ACT PMI ID, Type of diabetes, Year of diagnosis, family history and refer doctor name and address.

Method of management

Co Morbidities
Other current conditions reported by the patient at the assessment.

Medication
All current medications being used for the management of diabetes and other conditions at the time of the assessment.

General assessment

Hypoglycaemia requiring assistance (last 3 months)
An episode of hypoglycaemia that resulted in sufficient cognitive impairment or deceased level of consciousness that required treatment and management from another person.
A choice is made from the following list: 1-5/more than 5 episodes

Hypoglycaemia requiring assistance (last 3 months)
An episode of hypoglycaemia that resulted in sufficient cognitive impairment or deceased level of consciousness that required treatment and management from another person.
A choice is made from the following list: 1-5/more than 5 episodes

Hospitalised (last 12 months)
The patient has been admitted to hospital in the last 12 months and the condition of diabetes contributed to the admission.
A choice is made from the following list: Yes/No

Table
Trend data for weight, height, BMI and BP (lying and standing) based on the patient's status at sequential annual review visits.

Visual Acuity
Recorded based on assessment using a Snellen chart read at 6 metres.

Urinalysis
Results of a Multistix urinalysis and/or Microalbumin test conducted using a Clinitek Analyser.
A choice is made from the following list: Positive/Negative/Not done

Lifestyle Assessment
Current smoking status, alcohol intake and physical exercise including intensity and frequency.

Attendance last 12 months
Indicates the patient's reported attendance at a specific health professional within the last 12 months for a matter or review related to the condition of diabetes. This consultation included care that met the requirements of nationally recommended review standards of diabetes care in that discipline.

Nutrition assessment

Weight History
A choice is made from the following list:
Fluctuating/Increased/Decreased/Unintentional Loss/Cycling/No Change

Refers to the status of the clients weight over the previous 12 months. May include fluctuating, increased, decreased, unintentional loss, cycling, and no change.

Goal Weight
A number is entered.
Weight identified by the client and/or health professional as their weight goal.

Nutritional Knowledge
Ability to identify slow release CHOs
Ability to identify quick release CHOs
A choice is made from the following list: Limited/Adequate/Good/Not Applicable

Related to client's knowledge of the Glycaemic Index, including the role, types and sources of carbohydrate, how this impacts on diabetes management and their ability to identify high and low Glycaemic Index carbohydrate foods.

Ability to identify sources of saturated fat
A choice is made from the following list: Limited/Adequate/Good/Not Applicable

Related to client's knowledge of types and sources of fat, knowledge of the relationship between saturated fat and diabetes, and ability to identify food sources of saturated fat.

Ability to read and interpret food labels
A choice is made from the following list: Limited/Adequate/Good/Not Applicable

Related to the client's ability to understand information presented on food labels, with particular reference to carbohydrate and fat and how these impact on diabetes management.

Nutritional Summary
A choice is made from the following list:
Not meeting recommendations but client making progress/ Multiple changes were advised/ Irregular food intake/ Hard to assess/ Well balanced food intake, no adjustment required/ Generally well balanced, a few adjustments necessary/ Appears to be a lack of application of the nutrition advice/ Appears to be lack of understanding of the nutrition advice/ Client has not yet undertaken education

General statement related to the overall nutritional status of the client.

Diabetes education skills and knowledge assessement

Self-care Practices
Indicates the client's reported attendance at any of the following health professionals in the last 12 months: Podiatrist, Nutritionist, Diabetes Educator, Endocrinologist, and GP.

Indicates whether the patient performs home urinalysis, indicates results and assesses urinalysis technique.

Indicates whether patient performs self blood glucose monitoring, correct meter care, indicates self blood glucose monitoring lancing sites, self blood glucose monitoring frequency and times of day and assesses correct self blood glucose monitoring techniques and maintenance of records.

Indicates whether patient performs self-foot inspection.

Indicates whether patient carries quick acting carbohydrate for treatment of hypoglycaemia.

Indicates whether patient carries diabetes identification.

Indicates whether patient keeps glucagon at home.

Knowledge Assessment
Assessment on knowledge of Sick day, and Exercise Management, Optimal Glycaemic Targets, Standards of Care, Hyperglycaemia management, and Foot Care.

A choice is selected from a list: Adequate/Inadequate/Inadequate; Corrected/Inadequate; Follow up/Inadequate and Recommended

Referrals
Made to the indicated health professionals, programs or further specific individual education as a result of a skills and information assessment of current diabetes self-management

Health Professionals
A choice is made from the following list:
General Practitioner/Diabetes Educator/Ophthalmologist/Social Worker/Outreach Clinic/Dietitian/Psychologist/Endocrinologist/Podiatrist/Other

Programs
A choice is made from the following list:
Exercise/Foot Care/Quit Smoking/Support Group/Refresher/Weight Loss/Focus Group/Other

Further Education
A choice is made from the following list:
Sickness and Infection Management/Hypoglycaemia/DKA /Chronic Diabetes Complications/Exercise Plan/Optimal Glycaemic Targets/Pregnancy Planning/Travel Plan/Pre and Post Surgery Plan/Sexual Dysfunction/Other

Education recall
The patient is scheduled and will be recalled for their next general and education review in the identified month and year.

Podiatry assessement

Symptoms
Neurological Symptoms
Client is queried regarding experience of neurological symptoms:
None/ Paraesthesia/ Dysesthesia/ Anaesthesia/ Stereognosis/ Undetermined

Client is queried on frequency of these symptoms:
None/ Occasional/ Frequent/ Constant/ Unable to Determine

Neurological Treatment
A choice is made from the following list:
None/ Topical Physical/ Topical Chemical/ TENS/ Anti-epileptics/ Anti-depressants/ Other/ Unable to Determine

Vascular Symptoms
Client is queried regarding experience of cramping/ pains in legs/ feet:
None/ Intermittent Claudication/ Rest Pain/ Cramping Occasional/ Cramping Frequent

Trophic Changes
Assessment of feet and legs for signs of circulation problems
None/ Skin Atrophy/ Hair Atrophy/ Nail Atrophy

Foot Assessment
Tests are conducted on client's feet for signs of complications associated with diabetes:

Vibratory Threshold
Graduated tuning fork placed on tip of hallux. Test of client's ability to detect vibration sensation, carried on larger nerve fibres
Measured in octals
< 4 / 8 octals indicates impairment

Plantar Reflex
A pointed object is used to stimulate the plantar lateral aspect of foot in a single motion from heel to 5th MTP joint area. Commonly regarded as a Babinski test.
Measures plantar reflex indicating changes to motor nerves at local level Present/ Absent/ Diminished/ Increased

Soleal Reflex
The ankle reflex is assessed using a reflex hammer to assess if motor nerves are firing at the local level.
Present/ Absent/ Diminished/ Increased

Monofilament
A range of Semmes Weinstein monofilaments in graduated diameters and grams are used to assess ability to detect light touch.
Inability to detect 10grams pressure (5.07 diameter monofilament) is a reliable indicator of loss of protective sensation and thus client is at high risk of potential ulceration/ undetected trauma.
0.05/ 0.2/ 2.0/ 4.0/ 10.0/ 300.0/ Unable To Determine

Peripheral Neuropathy
Evaluation of above tests conducted provide podiatrist with evidence of nerve damage to distal nerves.
None/ Digital/ Forefoot/ Ankle/ Lower 1/3 Tibia/ Tibial Tuberosity/ Unable to Determine

Pulses
Dorsalis Pedis and Posterior Tibial Pulse:
Dorsalis Pedis pulse is palpated on foot. Assists in evaluating presence of PVD.
Bounding pulses may be present in peripheral neuropathy
Nil pulse/ Diminished/ Normal/ Bounding

Ankle Brachial Index
Only measured if pertinent to client's presenting condition.
Value entered

Foot Deformity
Podiatrist assesses for presence of bony prominences, deformities which place the foot at risk of trauma. Also to assess need for special footwear.
A choice is made from the following list:
Digital/ Hallux/ Forefoot/ Midfoot/ Rearfoot/ Other

Deformity Cause
A choice is made from the following list:
None/ Charcot's arthropathy/ Biomechanical/ Footwear/ Surgery/ Other

Amputated in Last 12 Months
A choice is made from the following list: No/ Yes

Amputation Level
Only appears if amputation selected.
A choice is made from the following list:
Hallux/ Lesser Digit/ Ray/ Forefoot/ Ankle/ Below Knee/ Above Knee

Podiatry Specific History
Some fields only appear on the report if they are relevant to the client.

Foot Specific Hospitalisation since last assessment
A choice is made from the following list: Yes/ No

Cause of Hospitalisation:
A choice is made from the following list:
Infected ulceration/ Cellulitis/ Amputation/ Surgical Debridement of an Ulcer/ Non-Diabetes related Trauma/ Osseous Reconstructive Surgery/ Unknown/ Other

Conditions Since Last Assessment
A choice is made from the following list:
None/ Mycotic/ Onychomycotic/ Bacterial/ Unknown/ Osteomyelitis/ Specific ulcer/ Other

Gangrene displays if selected

Dermal Foot Infection
A choice is made from the following list:
None/ Mycotic/ Onchomycotic/ Bacterial/ Unknown/ Other

Ulceration
Current Foot Ulceration
A choice is made from the following list: None/ Yes Current/ Yes Previous

Ulceration Type
A choice is made from the following list:
Neuropathic/ Vascular/ Mixed/ Surgical/ Pressure/ Unable to determine/ Other

Number of Active Ulcerations
Number will be entered

Osteomyelitis
A choice is made from the following list:
Don't know/ No/ Probable/ Definite/ Unable to Determine

Osteomyelitis Diagnosis
If Definite is selected above, then podiatrist must select the method of diagnosis.
Radiographs/ Bone Scan/ Labelled Bone Scan/ Other

Location of Ulceration
Location of ulcer will be shown as selected by podiatrist

Ulceration Treatment
A choice is made from the following list:
Hospitalisation/ Wound care/ Routine debridement/ Surgical debridement/ Temporary insole/ Temporary footwear/ Specialist footwear/ Vascular reconstruction/ Rehabilitation therapy/ Dermagraft (skin graft)/ Other

Ulceration Infection
A choice is made from the following list: Yes/ No/ Unknown

Treatment of Infection
A choice is made from the following list:
Topical/ Oral ABx/ Systemic ABx (hospital) Systemic ABx (Hospital in the Home)/ Unknown

Duration of Lesion (Actual)

Duration of Lesion (Treatment)

Client may have a period between the lesion appearing and seeking treatment

Assigned Risk Factor
A choice is made from the following list:
Low risk/ At risk/ High risk/ Low risk specific
Risk level evaluated as result of above assessment

Low risk = no pedal risk factors

At risk = no pedal risk factors, but client may have reasons to be unable to self care/ no carer able to care for feet

High risk = pedal risk factors present eg: PVD/ peripheral neuropathy

Low risk Specific = no pedal risk factors, but there may be a specific condition that requires further treatment by podiatrist – either ACTCC or private podiatrist

Additional comments

An empty space for any additional comments a GP may have about the Patient.