Date Available

5-1-2025

Year of Publication

2025

Document Type

DNP Project

Degree Name

Doctor of Nursing Practice

College

Nursing

Department/School/Program

Nursing

Faculty

Dr. Julianne Ossege

Committee Member

Dr. Christina Thompson

Faculty

Dr. Julianne Ewen

Abstract

Background: Foot ulcerations are a common diabetes-associated complication that can lead to significant morbidity, mortality, and financial burden for patients and health care systems. Health care providers (HCPs) play an important role in providing diabetic foot care. Despite national guidelines recommending HCPs perform an annual foot exam in all individuals with diabetes to recognize at-risk feet, research shows that many patients with type 2 diabetes (T2DM) do not receive routine diabetic foot exams (DFE) in the primary care setting.

Purpose: To evaluate the effect of provider education, a standardized DFE template, an electronic health record (EHR) alert, and online educational materials on provider adherence to diabetic foot screening and delivery of patient education. Objectives were to improve provider knowledge and confidence on diabetic foot screening, increase the frequency and comprehensive nature of screenings, and increase the delivery of foot care education to patients with T2DM.

Methods: This project was a quasi-experimental pretest-posttest design combined with a quality improvement process at a primary care clinic. Pre- and post-surveys evaluated provider knowledge and confidence in diabetic foot screening before and after an education session. A 3-month intervention period implemented a standardized DFE template, an EHR alert, and foot care patient education. Retrospective and prospective chart reviews identified annual foot exam rates, degree of exam completeness, and delivery of foot care patient education pre- and post-implementation.

Results: Four of five providers attended the education session. Four providers (80%) completed the pre-survey and three (75%) completed the post-survey. Provider knowledge scores improved after education (pre, mean=5.25 vs post, mean=9.00; p=0.14). There was a non-significant improvement in provider confidence scores after education (pre, mean=2.67 vs post, mean=3.67; p=.10). Sixty-four patients met the criteria for inclusion, 31 pre-intervention and 33 post-intervention. There was a non-significant increase in frequency of foot exams after the intervention (pre, n=16/31 [51.6%] vs post, n=20/33 [60.6%]; p=.469). The percentage of foot screenings with all three components increased post-intervention (pre, n=0/16 [0.0%] vs post, n=7/20 [35.0%]; p=0.011). There was a significant increase in patients with DFEs who had risk assessments completed during the intervention (p=.002). The DFE template had a 75% utilization rate during the project. There was no increase in delivery of diabetic foot education using Krames educational materials (pre, n=1/31[3.2%] vs post, n=1/33 [3%]; p=1.00).

Conclusion: This project revealed a care gap at this primary care clinic regarding frequency and quality of diabetic foot screenings. Interventions showed mixed but promising results impacting foot outcomes for patients with T2DM. Significant improvements in provider knowledge and an increase in the comprehensiveness of foot exams conducted post-implementation suggest that the intervention achieved some of its objectives and may offer similar benefits in other primary care settings.

Funding Information

The project described was supported by the National Institutes of Health National Center for Advancing Translational Sciences through grant number UL1TR001998. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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