Omission of Diabetic Foot Care Education in a Patient with Diabetes Mellitus

Case Summary

The patient has a diagnosis of diabetes mellitus; however, skilled nursing documentation does not include diabetic foot care education, and no related goals or interventions are identified in the plan of care.

Clinical Impact

Failure to provide and document diabetic foot care teaching may increase the risk of unrecognized skin breakdown, foot ulcers, infection, delayed wound healing, and lower-extremity amputation.

LUPA/Utilization Impact

Missing diabetic foot care education may reflect underutilization of medically necessary nursing interventions, increasing the risk of preventable complications, emergency department visits, hospitalization, and avoidable healthcare costs.

CMS Regulatory Impact

CMS Conditions of Participation require that the comprehensive assessment identify all relevant clinical risks and that the plan of care include appropriate goals and interventions. Failure to address diabetic foot care may be cited as incomplete assessment and inadequate care planning.

Expected Skilled Nursing Intervention

For patients with diabetes, skilled nursing should provide and document education on daily foot inspection, proper foot hygiene, use of protective footwear, early signs of infection, and when to notify the physician of concerning findings.

Business Impact

• CMS Star rating
• Cms regulatory impact