Foot and Nail Care Procedure

Will Holmes à Court
Will Holmes à Court
Last updated 
Healthy feet and toenails are an important contributor to safe mobility.

Procedure
The provision of this service is based on the Client having had a completed assessment by the Care Manager indicating that the client requires a basic level of foot and nail care and that no specific health or foot and nail conditions, such as diabetes, are present.
  1. During an assessment or review, the Clinical Care Manager (CCM) or Client Care Manager will ask the Client/Person Responsible how they wish to manage their foot and nail care. If the Client/Person Responsible states that they are having difficulty maintaining their foot and nail care, further questions will be asked to establish if there are any specific health or foot and nail conditions. 
  2. If there are none, an assessment of the client's individual foot and nail care needs is to be initiated, and a detailed support plan is to be written stating their individual foot and nail requirements (step by step, as well as any equipment and resources required).
  3. If the client wishes for a care staff member to perform nail and foot care, the CCM should consider completing an acknowledgement of risk from the client if there are associated risks involved.
  4. The assessment will be carried out in consultation with the Client/Person Responsible, family or carer, and, if necessary, their doctor and other health professionals if it identifies specific health or foot and nail conditions such as diabetes.
  5. If there is any doubt about assisting a client with foot and nail care, the Client/Person Responsible should be referred to their doctor or allied health specialist, with their consent, before commencing any care or assistance.
  6. The client will not receive Basic foot and nail care without a specific and current foot and nail care support plan written by the CCM.
  7. The Care or CCM is to complete the required validated assessment when the client is onboarded (within the required organisational time frame – 28 days?) This assessment will be completed in consultation with the client and/or Person Responsible in line with HWH Client Directed Care Principles (CDC) and Standard 3.
  8. The Care or CCM is only to reference official source documents when documenting the client’s medical diagnoses e.g. (of official source documents but not limited to the following) hospital/clinic discharge summaries from an accredited health provider; Comprehensive medical assessments; GP medical summaries, letters from specialists, medication listing from the supplying or consulting pharmacist, Aged Care Support Plan from ACAP by an ACAT or RAS Assessor or equivalent to name but a few. These source documents will be scanned and uploaded to Basecamp in the client's folder.
  9. If the Client has more complex foot and nail care needs, they must be assisted to have access to or are referred to an appropriate health professional to provide support as and when needed. If this is the case, HWH staff should not offer or provide foot and nail care. Document this referral and assist the client in promptly accessing this service.
  10. The resulting step-by-step procedures based on the relevant assessment (including care and clinical instructions by medical or allied health) should then be documented in the client’s Care Instructions in Basecamp.
  11. Episodes of care must be recorded in the client's shift notes. These must include a record of the date, time and duration of service.  The support worker’s or carer's name will be documented in the Client/Person Responsible shift notes. This record will also be used to report any observed changes in foot conditions/health, including any suspected triggers for change.
  12. Extraordinary or exception notes that need immediate attention must be brought to the manager's or CCM's attention by phone.
Care Assessment and Support Plan
  • The Client will receive an individualised care assessment to ascertain their foot and nail care requirements. This assessment will be conducted where appropriate with the Client/Person Responsible, family, doctor, and/or other health professionals.
  • The client will have a clear, individual foot and nail care support plan based on their assessed need using the following validated assessment tool (draft).
    Draft foot and nails Assessment Tool 23.6 KB View full-size Download
Referral to Other Health Professionals
Clients with more complex foot and nail care needs can access or be referred to an appropriate health professional who can provide support when needed.

Staff Training and Education
A competency-based training program supports this Basic Foot and Nail Care Procedure.
Training is available through Ausmed? Talent LMS?; competencies, etc.

Examples below:
Basic Foot and Nail Care in Aged Care | Ausmed
Basic Foot and Nail Care | Ausmed
  • written assessment and practical assessment at the end of the training day
  • A second practical assessment within 6 weeks of the training in the workplace to complete the ongoing workplace competency assessment required annually. 
  • This will involve a workplace observational assessment by the relevant HWH training coordinator.
Equipment
Support workers must be trained in using all equipment required to provide basic foot and
nail care. The list of equipment required will be documented in the Client care and support plan.

An example of Resources required may consist of the following:
  • Suitable chair for the support worker carrying out foot and nail care
  • A chair and footstool for the Client receiving foot and nail care
  • Appropriate lighting
  • Towels and bathmat
  • Bowl and water
  • Medi-wipes/baby wipes
  • Disposable gloves
  • Sorbolene cream or client's preferred emollient (please note the risks with applying this to the soles of the feet as it becomes a falls risk from slipping)
  • Cotton wool/ cotton wool buds
  • Nail clippers- Client/Person Responsible own equipment
  • Disposable emery boards (various sizes)
Infection Control and WHS
  • This service must be provided following HWH Infection Control and WHS Policies.
  • Support staff are to practice Standard Precautions and utilise appropriate PPE.
  • Support staff are to implement the principles of hand hygiene
  • Transmission-based precautions may need to be implemented in some cases on advice from the CCM, GP, Person Responsible or Infection Control
  • Single-use items are to be used and disposed of after each use
  • Staff are to complete the Hand Hygiene Learning Package annually
  • Support staff are to report any Infection Control or WHS issues to the CCM and/or coordinator and submit the required Incident Form and/ or the Hazard Form.
Reporting Changes and Concerns
In the event of an incident while assisting a client with foot and nail care, the support worker is to:
  • Remain calm and acknowledge that an incident has occurred
  • Identify the nature of the incident e.g. cut to the skin, equipment required
  • Administer basic first aid if necessary. Call 000 if it is a life-threatening event.
  • Once the client is stable. Seek assistance if available and call your CCM/coordinator to alert them.
  • Observe the Client/Person Responsible for changes in behaviour or well-being 
  • When convenient and safe to do so, record the incident in the Client's Shift and Case Notes
  • Complete an Incident Management Form and provide this report to your manager (CCM)
  • Provide comfort and reassurance to the client. 
  • In the event of an exposure to the staff member if a contagious infection is suspected, administer first aid, alert your CCM immediately and present to the ED department at your nearest site as soon as possible while taking appropriate infection control precautions. 
    • Follow the HWH Infection Control Occupational Exposure Management Procedure.
References