Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Christina M. Hernández


Laura Muñoz


The purpose of this quality improvement project was to increase adherence to the American Diabetes Association Standards of Medical Care in Diabetes—2016 recommendations for foot care and kidney disease screening for patients with diabetes mellitus type II in a primary care setting. Diabetes mellitus type II affects approximately 18.9-19.9 million, or 90-95%, of all diagnosed cases in the United States. Early detection and management decrease the risk of developing microvascular complications that may lead to neuropathy and nephropathy. Adults with diabetes mellitus type II, 20 years of age and older, accounted for approximately 73,000 non-traumatic lower-extremity amputations in 2011. Diabetes is the leading cause of kidney failure representing 44% of all new cases of renal failure. This quality improvement project was implemented by providing education for medical assistants and the provider. A pre-intervention audit of 50 charts revealed 10% documentation of foot care performed, 6% screening of kidney disease via microalbumin/creatinine testing, and 0% documented provision of educational handouts in patients with diabetes mellitus type II. For the quality improvement project the clinic began to perform and document foot care and order urine microalbumin/creatinine test more consistently with these recommendations. A post-intervention audit of 50 charts showed 50%, achievement in foot care performed and documented, 26 % achievement in microalbumin/creatinine testing, and 0% documentation of educational material. This project led by a Doctor of Nursing Practice student encompasses a higher level of clinical evaluation, organizational leadership and responsibility in providing evidence-based care.