Date of Award
4-2025
Degree Type
Dissertation
Degree Name
Doctor of Nursing (ND)
Department
Nursing
Chair
Isabel C. Zuniga-Perez, DNP, APRN, AGACNP-BC, RNFA
Co-Chair
William L. Hull, DNP, APRN, NNP-BC, RNC-NIC, C-ELBW, CNE, DCSD
Abstract
Introduction/Background: Diabetic retinopathy (DR) is a common microvascular complication of diabetes and a leading cause of blindness among working-age adults in the United States. In 2021, an estimated 9.60 million people were living with diabetic retinopathy in the United States and this number is projected to triple by 2050 (Lundeen et al., 2023). Early detection and timely treatment can prevent 95% of diabetes related eye disease, however many patients are unaware that they have this preventable, vision-threatening disease and between 50-60% of patients with diabetes do not adhere to the recommended yearly eye screening exam (National Eye Institute, 2024).
Problem: An 8-day practice assessment of a primary care clinic revealed a low diabetic retinopathy screening rate, with only 44% of patients with type 2 diabetes completing an eye exam within the past year. Lack of standardized patient education and missing documentation of optometrist/ophthalmology consultations was also identified. Subsequently, a protocol intervention was implemented and fifty-five patients with type 2 diabetes were evaluated. Only twenty-three patients had a documented diabetic retinopathy screening exam, resulting in a baseline screening rate of 41.8%. These findings revealed gaps in screening compliance, documentation, and patient education, emphasizing the need for improved processes to enhance diabetic retinopathy screening rates.
Method/Interventions: This quality improvement (QI) project aimed to improve annual diabetic eye exams in patients with type 2 diabetes by implementing a revision of the current diabetic screening program in a primary care clinic. The new protocol entailed education sessions to practice staff, incorporation of Diabetes Related Retinopathy Risk Test (DRRRT) into patient education, and re-emphasis on the importance of documentation and capture of optometrist and ophthalmologist consultations. Thirteen patients received education using the DRRRT, six patients were missing documentation of their eye exams, and thirteen patients were excluded from the education intervention as they were evaluated via telehealth which impeded the online use of the DRRRT. Pre and post intervention screening rates were evaluated. A Plan-Do-Study-Act (PDSA) quality improvement framework was used to implement and evaluate the intervention.
Results: Post-intervention data demonstrated that seven of the thirteen patients educated with the DRRRT completed the recommended eye exam within the project timeline, and clinic staff captured four out of six missing documents, resulting in an improved screening rate of 61.8%.
Conclusion/Implications for Practice: This project demonstrates the effectiveness of a multifaceted protocol intervention in improving annual diabetic retinopathy screening rates within a primary care clinic. Interventions that incorporate targeted staff education, personalized patient education, and improved documentation practices can significantly increase screening uptake, enabling early detection of diabetic retinopathy and timely treatment which prevents vision loss.
Recommended Citation
Piedra, Sandra, "Diabetic Retinopathy: Assessing Risk and Preventing Vision Loss" (2025). Cohort XIII. 7.
https://scholarworks.utep.edu/cohort_13/7