Franco, Ingrid L.. Improving identification of patients at risk for developing a diabetic foot ulcer in primary care. Retrieved from https://doi.org/doi:10.7282/t3-h6p8-g097
DescriptionPurpose of Project: To improve early identification of patients with diabetes at risk for developing a diabetic foot ulcer (DFU) in the primary care setting with the long-term goal of reducing DFUs.
Methodology: A quality improvement project with a pre- and post-intervention design with a retrospective chart review to evaluate the effect of a DFU prevention protocol based on the International Working Group on the Diabetic Foot (IWGDF) guidelines.
Results: A total of 36 patients were in the pre-intervention group and 36 in the post-intervention group (N=72). Risk stratification was assigned for 66 patients and distributed as follows: 66.7% very low risk; 19.7% low risk; 9.1% moderate risk, and 4.5% high risk. Compliance to risk stratification in the post-intervention group was low (n=2). However, this did not negatively impact patient care. In the post-intervention group, analysis of guideline interventions revealed that even in the absence of assignment of a defined risk category, the appropriate guideline interventions were provided based on the documentation (p=.005). Clinically significant findings in the post-intervention phase included a decrease in noncompliance to documented food care education from 27.8% (pre-intervention) to 8.3% (post-intervention). The number of referrals to podiatry increased from 52.8% in the pre-intervention group to 75.0% in the post-intervention group.
Implications for Practice: Increasing the awareness and knowledge of primary care providers (PCPs) on risk factors and stratification, is an important step in the management of patients at risk for DFUs. Additionally, the intensity and frequency of education provided to patients with diabetes should be based on risk. Healthcare policy is needed to improve access to diabetic shoes by permitting Advanced Practice Nurses (APNs) to certify their medical need. Clinicians can ensure high quality care by participating in the Merit-based Incentive System (MIPS) with a Clinical Quality Measure (CQM) specific to diabetic foot screening. To reduce the overall financial burden of DFUs, more emphasis on recognizing early signs of pre-ulceration along with screening of risk factors is needed.