Date of Award
2025
Degree Type
Dissertation
Degree Name
Doctor of Nursing (ND)
Department
Nursing
Chair
Leslie Robbins PhD, APRN, PMHCNS-BC, PMHNP-BC, FAANP, ANEF
Abstract
The prevalence of Diabetes Mellitus Type II (DMII) is a significant global health concern, affecting approximately 451 million individuals worldwide, with projections indicating an increase to 693 million by 2045. As the eighth leading cause of global disease burden, DMII is associated with serious complications, including diabetes-related foot disease (DFD), which is the leading cause of disability among diabetic patients. An 8-day clinical practice log conducted at a primary care clinic in the Southwest United States revealed that a significant number of diabetic patients had not undergone a diabetic foot exam in the past year.
Objective: This quality improvement (QI) project aimed to increase the frequency of diabetic foot exams performed within the clinic's diabetic patient population.
Method: The project involved conducting a standardized diabetic foot exam and assigning a risk stratification score to each patient screened. This Quality Improvement (QI) project was based on an 8-day practice assessment log performed at a privately owned, for-profit primary care organization that operates five clinics in a border town in the Southwestern United States. The company employs six providers, including two physicians and four nurse practitioners, who rotate among all the clinics on a weekly basis. Each clinic is situated in different geographical area within the city, each presenting its own unique demographics and barriers. The model used was Rosswurm and Larabee’s Model for Evidence Based Practice change, a model that facilitates a shift from traditional and intuition-driven practice to implement evidence-based changes into practice. Additionally, QI project employed a hybrid of the Toyota Production System (TPS- Lean Model) and Six Sigma to decrease variance and increase standardization.
Results: The project resulted in more providers conducting DMII foot exams and accurately assigning risk stratification scores. Before the intervention, only about 3% (~35 of 1200) of DMII patients were properly screened, after the intervention, 9% (115 of 1269) of all DMII patients received the appropriate screening and risk stratification score assignment.
Conclusion: Engagement from staff and administration facilitated the identification of patients with DMII, enabling providers to be alerted of DMII diagnoses and associated risk stratification scores (both initial and follow-up), thereby ensuring the consistent conduct of DMII foot exams.
Recommended Citation
Herrera, Jossue, "Walk the Line: I Keep a Close Watch on These Feet of Mine QI Project to Increase the Frequency of Diabetic Foot Exams" (2025). Cohort XIII. 11.
https://scholarworks.utep.edu/cohort_13/11