Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Nancy Magnuson


Nancy Magnuson

April Sun

Patricia Hendrickson


Problem- One in four U.S. Veterans have Diabetes Mellitus, and one in four U.S. Veterans with diabetes will develop a diabetic foot complication. There is currently no protocol for healthcare providers to perform foot screenings on diabetic patients at each visit. Utilizing a foot screening at each visit for high risk diabetic patients may help to recognize problems sooner, making treatment easier and less aggressive.

Methods- This quality improvement initiative was a retrospective and prospective record review before and after evidence based three-minute foot exams were implemented. A convenience sample of 50 patient medical records were reviewed to collect demographical, clinical indicators, and to establish the frequency of foot exams, education, detection of complication and treatment or referral with the current standard of care. A convenience sample of 20 patients, who were seen in a primary care face to face visit, had a retrospective chart review to collect the same data set as the standard of care baseline group.

Results- No differences between the standard group and the intervention group were found in comparing age, gender, war era, agent orange exposure, or Hbg-A1C lab values. The Fisher’s Exact test showed statistical significance of documented foot exams and documented patient education in the intervention group, pre- and post-implementation with a p value of 0.001. Two patients (10%) had an undiagnosed diabetic foot complication identified on the foot exam and treatment or referral initiated.

Implications for Practice- Implementing an easy to use foot exam for diabetic patients at every visit is significant in improved patient outcomes. Timely recognition of diabetic foot complications also entails easier and less aggressive treatment.

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