Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Michael D. Moon


Javier C. Bocanegra


Diabetes is a significant public health problem, decreasing quality of life, causing disability and death (CDC, 2017; Foos et al., 2015; Grover & Joshi, 2015). Uncontrolled diabetes can lead to several eye complications including retinopathy and blindness (ADA, 2013; Liu & Swearingen, 2017). As the number of people afflicted with diabetes rises, the need for diabetic eye examination screenings also increases to prevent disability, improve quality of life and prevent blindness (ADA, 2018; Fisher et al., 2016; Garber et al., 2015; Raman et al., 2016).

The purpose of this project was to increase the rate of diabetic eye examination referrals, completion of diabetic eye examinations and documentation of results in the medical records. The objectives were to improve diabetic eye examination referrals by 30% and increase the referral loop closure by 40%.

Interventions included 2 training changes, 3 clinic processes changes, 4 EMR changes and 4 paper resource changes. Nine of 13 interventions were successfully implemented.

Results showed either a marginal improvement or a regression in the number of diabetic eye examinations. Although this project failed to meet the objectives, a great deal was learned about clinical practice guidelines.

More quality improvement projects are needed to identify strategies that will help increase the number of annual diabetic eye examinations that are performed in the clinical practice setting. Projects like this help identify barriers to improved health care such as patient motivation to adhere to treatment recommendations.