Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Christina Hernandez


Maher Saloum


Unmanaged Type 2 diabetes leads to macrovascular changes that affect the lower extremities, thereby damaging the sensory nerve fibers and leading to diabetic peripheral neuropathy. These patients may not be able to feel pain, heat, or cold in their lower extremities and often describe feelings of numbness and tingling. This sensory deficit may lead to the development of diabetic foot ulcers which often result in amputation. These preventable foot complications may be identified promptly with adequate diabetic foot exams. Comprehensive diabetic foot examinations reduce the occurrences of foot complications associated with uncontrolled glucose management and improves health outcomes for patients with Type 2 diabetes. The purpose of this quality improvement project is to implement a standardized system for comprehensive diabetic foot examinations as recommended by evidence-based guidelines into clinical practice at a primary care clinic, which will enhance diabetic foot health care performed by providers. Through the intervention period of March-May 2019, one-hundred percent of 141 patients received a comprehensive diabetic foot exam. This was facilitated by medical assistants who instructed patients to remove their shoes and socks before the physician entered the exam room. All patients also received an educational handout from the American Diabetic Association. These outcomes were documented in the Diabetic Foot Exam flowsheet and scanned to the electronic medical record.