Date Available


Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Elizabeth Tovar

Clinical Mentor

Jessica Sass

Committee Member

Dr. Lynne Jensen

Committee Member

Dr. Angela Grubbs



BACKGROUND: Diabetes mellitus (DM) is the leading cause of new blindness in American adults. As the number of people with type 2 diabetes continues to increase, the total number of people affected by diabetic retinopathy (DR) will continue to rise. Improved access to screening for DR, followed by treatment, if necessary, can reduce the progression to vision loss. Despite national recommendations, less than half of Americans with DM complete annual diabetic retinopathy screenings (DRS).

PURPOSE: The purpose of this project was to improve assessment, education, documentation, and ordering of DRS for patients with a diagnosis of type 1 and/or type 2 diabetes mellitus in a primary care setting through provider reminders and patient education.

METHODS: This project was a single-center, mixed methods quality improvement project that took place at a family medicine clinic in central Kentucky and was guided by the FOCUS-PDSA model for improvement. A quality improvement (QI) team conducted two PDSA cycles involving 1) family medicine resident education and 2) manually updating the EMR to reflect up to date DRS. A DNP student led a focus group to further identify barriers and facilitators to assessing, documenting, and ordering DRS. A third PDSA cycle incorporating provider and staff reminders as well as patient education was implemented. Data was gathered through retrospective chart reviews between July and October 2020.

RESULTS: Descriptive data was reviewed for PDSA cycles one and two. Descriptive data showed that provider education did not improve documentation and manual review of the EMR to identify results from ophthalmology was effective. There were no significant differences found in PDSA cycle three for assessment (p=0.35), documentation (p=0.99), or ordering (p=0.48) of DRS after intervention. Statistically significant results were found for the association between assessing for DRS and having an annual review completed (p=0.002).

CONCLUSIONS: Findings suggest that DRS rates could improve with a more robust EMR system, having a reminder system in place, and having annual reviews completed that included DRS. Future investigation should include comparison of these variables and their influence on provider assessment, documentation, and ordering of DRS.

Keywords: diabetic retinopathy, screening, quality improvement