Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Karen L. Weis


The incidence of diabetes and its complications is escalating, with over 34.2 million adults in the US having diabetes (CDC, 2020). Despite a decade-long decline in lower-extremity amputations, the incidence is growing (Nichols, 2019), with little emphasis on preventive foot evaluations within primary care. The purpose of this project was the implementation of a multi-faceted program aimed at early identification of lower extremity complications with focused patient education, improved assessment, and documentation, and referral for specialty care. The intervention process included staff training, patient education, foot examination, monofilament testing, pinprick tests, ankle reflex, and tuning fork test. Foot abnormality, loss of protective sensation, differentiation of sharp and dull sensation, vibratory sensation or perceptions, and ankle reflexes were evaluated and measured with the Michigan Neuropathy Screening Instrument (MNSI) to provide objective scoring and determine referrals. Between January and May 2021, 100% of diabetic patients (n=197) received comprehensive foot assessments and specialty referrals compared to near-zero % foot assessments in the previous year. We identified 14.1% patients who had high self-foot assessment scores indicating an increased risk of foot ulcers and amputation. All patients received education; 37% had bilateral foot abnormalities, of which 21% required referrals. Approximately 43% of the patients assessed had decreased sensation, without ulcerations. Documentation was completed 100%. Approximately 50% of diabetic foot complications can be prevented with foot care programs that include patient education, regular examination, testing, footwear, nail care, and specialty referrals; all components that can be implemented and sustained by nurse practitioners within primary care.