Abstract
Background and Purpose: Diabetes mellitus is associated with a series of macro and microvascular alterations that are associated with a number of complications. Foot ulceration affects an estimated 2-4% of patients possibly leading to severe morbidity and premature mortality. The purpose of this quality improvement project was to improve foot inspections and patient teaching about diabetic foot care for all patients with diabetes in the primary care setting.|Methods: This quality improvement project was conducted at a rural primary care clinic in Iowa. The sample consisted of three providers and ten nurses who provided care for patients in the clinic. Pre-intervention chart reviews on foot inspections and education were collected as baseline data prior to the intervention. For the intervention, providers and nurses completed a pre-test, educational session, and post-test regarding prevention of diabetic foot ulcerations. Follow-up chart reviews were completed on foot inspections and education post-intervention.|Results: Pre-intervention data was collected between the months of August and September showing that 15 visual inspections were completed out of the 218 patients with diabetes who were seen in the at the Washington County Hospital and Clinics Family Medicine Clinic (WCHC). No teaching on foot care in diabetes was documented. During the posttest period, December and January, 207 patients with diabetes were seen at WCHC. Of these patients, 95 had documentation of foot examinations and 35 had documentation of diabetic foot care education. Comparative data shows an increase of 45.8% in the documentation of foot examinations and an increase of 17.8% in the documentation of diabetic foot care education.|Implications for Practice: To ensure the timely diagnosis and treatment of diabetic foot ulcers, regular visual foot exams, and education should be completed at each patient encounter. In addition, sensory examinations to test for diabetic neuropathy should be completed annually. With regular examination, providers can significantly reduce morbidity and mortality associated with diabetic ulcers/amputations while reducing the total cost of caring for the patient with diabetes.|Keywords: Diabetes, Diabetic Ulcer, Visual Foot Exam, Sensory Foot Exam