Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Christina M. Hernandez


The purpose of this quality improvement project was to increase performance and documentation of provider comprehensive foot exams (CFEs) by 50% among patients with Type 2 diabetes (T2DM) in a small clinic in the southwestern United States.

The project leader assessed clinic systems including the electronic health record (EHR) to identify means to increase CFE completion and documentation rate for patients with T2DM being seen for a chronic disease management (CDM) appointment. A process was created to incorporate a hardcopy CFE documentation form into the EHR and create a pop-up care reminder notification system. Staff and the provider were educated on the new process, supplies were obtained, and the project leader implemented this project in the spring of 2020. The project leader monitored outcomes through a formative and summative evaluation plan and addressed barriers as they were identified. The COVID-19 pandemic impacted clinic practices in March 2020 and led to modification of project outcomes as the platform for appointments changed from in person to telehealth.

The project outcome was achieved as 52% of patients with T2DM who were seen during a CDM appointments received a CFE that was documented completely. The average increase in appointment time was 10 minutes. Including CFEs in CDM appointments can support the identification of foot ulcers at an early stage and prevent or delay lower extremity amputations. EHR systems should be evaluated for the capacity to support electronic tracking and documentation of these assessments