Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Holly Cassells


Purpose: To improve a South Texas primary care clinic’s diabetes management system by implementation of a quality improvement intervention to help staff and medical providers increase adherence to the American Diabetes Association standards of care related to screening referrals and orders for urine microalbumin, in order to improve self-care and health outcomes for adult patients with diabetes. Background and Problem: Diabetes is the 7th leading cause of death in the United States and the cause of vision loss, amputations, and end-stage renal disease. The patients at the Wellness Center do not consistently receive routine screenings for neuropathy, retinopathy, nephropathy, microalbumin, and diabetes self-management education as recommended. Methods: The Doctor of Nursing Practice student conducted a quality improvement project introducing practice-aids to reinforce adherence to the American Diabetes Association recommended diabetes guidelines for screening and referrals. Pre and post intervention evaluation methods were employed. Results: Provider adherence to diabetes guidelines was measured through documentation in patient records before (N = 50) and after (N = 50) the interventions. The number of referrals to ophthalmologist increased from 48% to 100%, podiatry from 60% to 100%, diabetes selfmanagement education from 10% to 98%, microalbumin screening from 24% to 98%, and inspection of patient feet from 0% to 100%. Nine other quality improvement indicators were also significantly improved. Conclusions: Practice aids were effective in increasing adherence to the recommended American Diabetes Association diabetes treatment guidelines.