Date of Award

5-2020

Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Nola A. Schmidt

Abstract

Diabetes mellitus (DM) is one of the most common metabolic diseases worldwide. It can lead to complications in many parts of the body and can increase overall risk of dying prematurely (World Health Organization (WHO), 2016). Diabetic peripheral neuropathy (DPN) in the feet is one of the most frequent complications of DM (Wang et al., 2017). Other lower extremity complications which can occur as a result of diabetic foot complication (DFC) includes peripheral artery disease (PAD), infection, ulcer and amputation. One of the obstacles for preventing (DFC) is the lack of examinations of the feet in clinical practice (Feitosa et al., 2016). Guided by the Iowa Model Revised (Iowa Model Collaborative, 2017), The purpose of this 12- week project was to implement best practice recommendations for the provision of diabetic foot care into primary care. A review of literature was performed by the project leader (PL) which generated 11 pieces of relevant evidence that met the inclusion criteria. Participants of this project included 531 adult diabetic patients, ages 18-74, who were seen in the primary care setting. Best practice recommendation for interventions included: (a) provider history and foot physical assessment including provider use of the Semmes-Weinstein Monofilament (SWM) tool to assess for actual diabetic foot complication, (b) assessment of footwear, (c) provision of patient education, and (d) initiating multidisciplinary care by educating clinicians, planning a workflow, and providing ongoing feedback. The primary outcome measured was appropriate referrals, defined as a referral to the specialty clinic that is ordered by the provider for individuals with a SWM tool score of 3 and a ‘yes” for referral that has been documented by the provider in the EMR. Findings showed that the interventions improved appropriate referral (X2(1) = 72.657; p <.001), as well as the secondary outcomes of provider foot assessment (X2(1) =93.209; p <.001) and patient follow-up compliance to the Podiatry clinic (PC) following referral (X2(1) = 88.7014; p <.001).

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