Date of Completion

5-2-2023

Document Type

Open Access Capstone

Degree Name

Doctor of Nursing Practice (DNP)

Faculty Advisor

Eileen Stuart-Shor

Site Advisor

Ann Glasman

Second Reader

Maura Moran Brain

Abstract

BACKGROUND: Diabetes Mellitus is a growing health problem in America. Uncontrolled diabetes can result in vascularcomplications. One of the most common complications of diabetes is diabetic peripheral neuropathy. Early foot carescreening can help prevent Diabetic peripheral neuropathy and other complications such as skin injuries, burns, falls,infection, lower- extremity amputations, and peripheral arterial disease. Interventions that have been shown to improve theidentification of diabetes foot complications include staff education, screening and assessment, use of monofilament,tuning fork for diabetic foot assessment, patient education/ self-care, standardization, and use of electronic medical records(EMR)/electronic reminders.

METHODS: The Plan Do Study Act method of quality improvement was used for this quality improvement project. A literature review was conducted. Data were collected and analyzed using both qualitative and quantitative methods. Thedata were assessed to determine the percentage of diabetic foot exams documented, the elements included in thedocumentation, and the number of patients referred to specialists. Huddles and staff surveys were used to determine thefeasibility and value of the intervention.

INTERVENTION: A standardized diabetic foot care pathway was implemented in a primary care clinic. Adult patients witha diagnosis of diabetes were identified at non-urgent visits. Diabetic foot care was offered and carried out. Patients andstaff were educated. The assessments were documented in the charts. Patients with abnormal findings on foot exams were either referred for ankle-brachial index tests and/or to specialists (podiatrist, vascular) or followed by a Primary care provider for mild abnormalities.

RESULTS: The project was implemented over 3 months. A total of 92 diabetic foot exams were completed. Of the 92 patients, 30 had abnormal exams (33%) and 15 had abnormal findings that warranted a referral to specialists. The staff was educated. The staff reported satisfaction with the pathway.

CONCLUSION: Implementing the new diabetic foot care pathway was clinically significant for the practice. It allowed the diagnosis of new conditions for the patients, which helped in the early prevention of foot complications. The new pathway consequently improved patient care.

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