Implementation of a Comprehensive Diabetic Foot Exam Protocol in Rural Primary Care


Background: Patients with type-2 diabetes mellitus have an increased risk for foot ulcerations and lower extremity amputations.  Evidence-based practice guidelines recommend annual foot screening at least yearly for patients with type-2 diabetes.  Comprehensive foot exams that include assessments for loss of protective sensation and peripheral artery disease prove beneficial in reducing morbidity and decreasing the incidence of diabetic foot ulcerations.  Despite the known benefits of preventive screenings, a limited number of rural providers adhere to well-established treatment guidelines for patients with type-2 diabetes.

Purpose/Aim: The purpose of this quality improvement project was to increase the number of comprehensive foot examinations for adults with type-2 diabetes mellitus in rural primary care.  The overarching aim was that 75% of adult patients with type-2 diabetes would consistently experience a comprehensive foot exam and risk assessment within 15 weeks of project initiation.

Methods: The quality improvement project design involved the introduction of a comprehensive diabetic foot exam protocol in four Rural Health Clinics.  Utilizing the Plan-Study-Do-Act quality improvement model, retrospective data was collected from 60 patients to evaluate the percent of patients with type-2 diabetes that received a foot exam in 2017.  Educational programs were presented to primary care providers and clinic nurses to introduce the protocol.  The project implementation occurred as a 1-week pilot in one Rural Health Clinic then system-wide for 14 weeks.

 Results:  The retrospective data revealed 42% of patients with type-2 diabetes received a foot exam in 2017.   All primary care providers and clinic nurses attended educational sessions on screening guidelines and protocol introduction.  Following the 15-week project, 68% of patients with type-2 diabetes experienced a comprehensive foot exam and risk assessment.

Conclusions: Implementation of a clinically relevant tool in rural primary care resulted in significant improvement in primary care provider adherence to recommended diabetes foot screening guidelines.

Keywords: Type-2 Diabetes, Rural, Adults, Foot Exam, Guidelines


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