Title

Improving Diabetic Foot Screening in a Primary Care Clinic for Homeless Adults: A Quality Improvement Project

Date of Degree

12-2019

Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)

Program

Nursing

Advisor

Ana Tabet

Advisor

Ruth Morgan

Abstract

The purpose of this project was to increase the adherence of clinic providers at the homeless primary care clinic by implementing the American Diabetes Association Clinical Guidelines for the evaluation and management of Type 2 diabetes with foot care. Type 2 diabetes is a chronic condition that affects 13% of the Texas adult population (Centers for Disease Control and Prevention, 2014). The homeless person's main method of transportation is walking. The complications of undiagnosed foot problems include reduced mobility, pain, lower limb amputations, and difficulty controlling chronic diseases including diabetes and depression. Provider responsibilities include screening for diabetes in all patients over the age of 18, documenting positive diagnosis in the electronic medical record, screening patients with diabetes for foot problems with appropriate screening tools and appropriate referral to podiatry.

A retrospective chart review was conducted where 35 patient charts were reviewed and de-identified. The pre- and post interventions were analyzed. At project completion, high no-show rates among patients for appointments and the short project duration were major limitations of the project. The interventions implemented were helpful in increasing provider documentation of the patients that did show up. Homeless people are exposed to the elements adding to their daily struggles, which indicate a need for continuous work on intervention models that will facilitate provider adherence with subsequent referral for treatment if needed.

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