Implementing an Evidenced-Based Quality Improvement Project to Standardize Foot Screening in Adults with Type 2 Diabetes
Loading...
Date
2024-05
Authors
Seiter, Allison
Journal Title
Journal ISSN
Volume Title
Publisher
The Ohio State University
Abstract
Introduction: In the United States, over 37 million adults have type 2 diabetes mellitus (T2DM), with 23% of them unaware of their condition. Diabetes contributes to significant health complications, including over 270,000 deaths, 16 million emergency visits, and 7.8 million hospitalizations annually. Individuals with T2DM are prone to peripheral arterial disease and neuropathy; approximately 25% of people with diabetes will develop a foot ulcer during their lifetime, leading to significant medical expenses, lost productivity, and reduced quality of life. Regular screening and education can prevent up to 85% of diabetes-related amputations. Evidenced- based practice guidelines recommend integrating a process for standardized foot screening in primary care.
Purpose: The purpose of this project was to standardize foot screening for patients with T2DM within a comprehensive primary care clinic.
Methods: This quality improvement project standardized foot screening using the Inlow's 60-Second Diabetic Foot Screen, a validated, rapid screening tool created for primary care that includes use of the 10-g monofilament test and key risk stratification scoring. Utilizing the Plan-Study-Do-Act model, an educational in-service during the project kick-off provided an opportunity for clinicians and staff to practice using the Inlow’s Screen. The healthcare team involved in integrating the standardized screening in practice included four family medicine physicians, two nurse practitioners, one licensed practical nurse, nine medical assistants, the office manager, and several nonclinical office specialists.
Results: Pre-implantation data was collected from primary care visits to evaluate the percent of patients with T2DM who received an annual foot exam within the four weeks prior to the project; the data revealed 49.8% of patients with T2DM (n=287) received a foot exam utilizing a monofilament tool. Following project implementation, 55% of adults with T2DM seen in the office (n=209) had a completed comprehensive foot exam. Based on scores from the Inlow's 60-Second Diabetic Foot Screen, three patient referrals were placed for specialist evaluation of their DFU risks.
Implications for Practice: Implementation of an evidenced-based, standardized foot screening in primary care can result in an increase of completed foot exams for individuals with T2DM. Leadership buy-in and team collaboration is needed to create an environment that supports practice change.
Description
Keywords
Adults, type 2 diabetes mellitus, foot screening [tool], diabetic foot ulcers, primary care office