Document Type

DNP Project

Publication Date


Degree Name

Doctor of Nursing Practice

Faculty Advisor

Constance Glenn DNP, APRN, FNP-BC, CNE

Practice Mentor

Michael DeMasi, DNP, APRN, FNP-BC


Background: Foot conditions and disorders are prevalent concerns for the medically underserved population, that can manifest through chronic illnesses like diabetes, peripheral vascular disease, and hypertension, especially if these conditions go undetected or unmanaged for periods of time. This population is faced with complex challenges and are at risk of illness due to inequities and disparities in access to health care services. They are known to suffer from poor health and can be reluctant to seek healthcare except in crisis. Walking is a common mode of transportation among underserved individuals and increased risks of physical injury, poor hygiene, and inadequate footwear have been cited as contributing factors to the development of foot problems. Without timely identification and appropriate treatment foot and ankle problems are a concern; they can cause significant discomfort and pain and may escalate from a minor problem to a very serious one, or lead to infections and amputations (Mullins et al., 2022). Comprehensive foot examinations are essential in detecting foot pathologies in order to sustain movement and quality of life. The purpose of this evidence-based quality improvement project was to implement a risk stratification screening tool for all foot examinations, implement a follow up appointment system based on risk score and provide patient education on self-foot care within a free clinic setting. Based on findings, risk scores would be determined to be low, medium, or high risk and have recommended follow up care based on the risk score.

Methods/Interventions: The Model for Healthcare Improvement was followed for the planning, implementation, and evaluation of this project. A foot screening tool already in use at the clinic was modified to include a risk stratification tool. The tool was developed by the DNP team and approved for use by the internal quality improvement committee at the clinic. Data was assessed over a 12- week period, to determine the percentage of foot exams performed, risk stratification assigned to each patient, number of referrals and follow up appointments made compared to a review of foot exams performed prior to the initiation of the risk stratification tool.

Results: During 12 weeks of implementation, a total of 54 foot screenings were completed; 32 screenings using the original form with no risk stratification score and 22 using the revised form. Of the 32 patients screened, only 4 patients were referred to the medical provider for a follow-up appointment. 22 patients were screened using the revised form that assigned a risk stratification score to each patient. Of those screened, 7 (31%) were found to be low risk, 13 (59%) medium risk and 2 (9%) high risk. The results identified that 68 % of patients received a follow up appointment within 1 week based on significant screening findings versus 12.5% of patients where no risk score was assessed.

Conclusion: These results showed that implementing the risk stratification foot screening tool was clinically significant for the clinic, as it allowed for the screening and detection of foot conditions of patients as well as recommendations for follow-up care. Implementation of this tool helped to increase the amount of follow up appointments with a healthcare provider compared to using the foot screening tool with no risk stratification score. The tool helped to streamline follow up appointments based on risk score, which ensured that more patients were seen in a timely manner to prevent the progression of foot complications and disease.


A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.

Creative Commons License

Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.

Included in

Nursing Commons



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.