Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Cathy Koetting


Cathy Koetting

Roxanne Vandermause

Patricia Hendrickson


Problem: Peripheral artery disease (PAD) affects eight million Americans and is the third leading cause of death in the U.S. in people 60-85 years of age. Veterans are at a 45% greater risk to develop PAD than non-veterans. Left untreated, PAD can progress to hospitalization for revascularization, amputation, or death. The American Heart Association (AHA) recommends using a standardized screening tool for the diagnosis of PAD; however, a lack of standardized screening is problematic in veterans receiving proper intervention.

Methods: This quality improvement (QI) project utilized a descriptive, observational design. The American Heart Association (AHA) screening tool was administered by primary care providers (PCPs) to a convenience sample of adult patients aged 50-85 years old in the primary care setting. The number of Ankle Brachial Indices (ABI) and referrals retrieved in a retrospective record review 3 months prior to education in the use of the ABI and 3 months after education were compared.

Quantitative data were collected during the face-to-face clinic visits. Data collected during the time of this (QI) project included the number of screenings administered, number of ABI tests ordered and the number of referrals to vascular specialty generated.

Results: In the 3 months prior to the implementation of the screening tool, the PCP referred to vascular specialty 18 times and after the tool was implemented only once. The number of ABI tests ordered was 45 prior, and 11 tests ordered after the implementation, the average number of risk factors 2.61 and the average number of symptoms were 1.11.

Implications for Practice: The implementation of the screening tool in the primary care settings could increase education among primary care providers on early identification of PAD with treatment and management. Standardized care among primary care providers, improved effectiveness of care in the primary care setting, and improved patient healthcare outcomes could eliminate unnecessary referrals and reduce the serious complications of PAD.

Included in

Nursing Commons