Doctor of Nursing Practice
Susan DeNisco, DNP, APRN, FNP-BC, FAANP
Background: Healthcare providers manage chronic health concerns by reducing the risk of diabetic complications among their patient population. In 2017, diabetes was the seventh leading cause of death in the United States and Connecticut. In Connecticut, there are 19,500 newly diagnosed diabetics and four Connecticut cities have higher occurrence of diabetes: Waterbury, New Britain, Hartford, and Bridgeport. Bridgeport Primary Care (BPC) had no policy or procedure in place to require the providers to complete a routine diabetic foot exam. The aim of this project was to promote and implement a tool to assist the BPC providers in evaluating adult diabetics feet to reduce the risk of diabetic foot complications.
Methods: Over 12-weeks, BPC patients with T2DM between the ages 45-64 with hemoglobin A1cs above 8%, who presented for an office visit with BPC provider, would have a diabetic foot exam. Patients were triaged with a series of yes/no questions and asked to remove their shoes and socks prior to the provider entering the room allowing for the diabetic foot exam to be completed. Referrals and follow ups were made according to the American Diabetes Association guidelines after the office visit.
Results: The goal was for the provider to perform 75% of the diabetic foot exams on T2DM between the ages 45-64 with hemoglobin A1cs above 8%, during the implementation of the workflow over 12-weeks. Of the 107 T2DM aged 45-64, 25 patients were high risk diabetic with elevated hemoglobin A1cs. Fifteen (60%) diabetic foot exams were completed over 12-weeks. The top two ICD 10 codes for T2DM patients aged 45-64 were: T2DM with Diabetic Polyneuropathy (E11.42) and Diabetes Mellitus with Peripheral Angiopathy without Gangrene (E11.51).
Conclusion: By performing diabetic foot exams at primary care visits, providers can identify early foot infections, nerve damage, and or circulation problems. This would lead to higher quality of care by referring to specialist who can assist in management of chronic foot concerns which can reduce recurrent hospitalizations, disabling complications and life-threating events.
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Alvarez, S. (2022). Implementation of 3-minute diabetic foot exam for at risk diabetic patients in urban primary care setting [Unpublished DNP project]. Sacred Heart University.