Prevention, Recognition, and Appropriate Referral of Diabetic Foot Ulcers in Long-Term Care

Abstract

Foot ulceration can lead to several health complications if left untreated, and many of these health complications are preventable with proper screening. Early recognition can prevent or delay the onset of adverse outcomes for patients. There are many different screening tools available. However, there is a lack of a systematic process and consistent training for staff nurses in a long-term care setting regarding diabetic foot assessment, leading to inadequate screening. There were three aims of this project. The first aim was to determine the knowledge and practice needs of staff nurses in conducting diabetic foot ulcer assessment in a long-term care setting. The second aim was to develop and implement an effective education intervention for staff nurses to properly assess diabetic long-term care residents for diabetic foot ulcers. The third aim was to implement a valid and reliable diabetic foot ulcer assessment tool and assessment process for staff nurses in a long-term care setting. This quality improvement project used a pre- and post-implementation design to assess diabetic foot ulcer prevention, recognition, and referral. An assessment form and an instructional tool were introduced during this project. This project took place at a large long-term care and rehabilitation facility in Overland Park, KS. The project occurred as part of diabetic foot assessment on residents’ assigned bath day. The participants of the project included staff nurses working with diabetic patients in the facility. The data were collected using the Inlow’s Simplified 60-Second Diabetic Screen. Descriptive statistics were calculated for all project variables. A paired t-test was used to assess the change in nurses’ knowledge about diabetic foot ulcer assessment and a two-sample t-test was used to determine the change in the percentage of diabetic residents receiving a diabetic foot assessment. Completion of the Pre- and Post-Test Knowledge Questionnaire demonstrated a significant increase in the mean percentage of correct answers (71.4% pre-test to 86.5% post-test). Pre-intervention, documentation of diabetic foot ulcer assessments was missing for 46.4% of residents and incomplete for 53.6%. After the intervention, 100% of the assessments were completed. The rate of diabetic foot assessment referrals significantly increased from 7.1% pre-intervention to 49.2% post-intervention. This project improved nursing knowledge, assessment skills, documentation, and referral mechanisms for residents with diabetes. APRNs play an important role in providing education and raising nursing standards of care as they are well-positioned to be involved in quality improvement initiatives. The results of this project demonstrated improved nurses’ assessment skills, proper documentation and referral process for residents with diabetes who are at risk for developing foot ulcer and its complications. Additionally, nurses’ evaluation of the project yielded favorable feedback regarding future utilization and ease of use of the Simplified 60-Second Diabetic Foot Screen. Hence, this quality improvement project has met its objectives and has demonstrated positive outcomes upon its completion.