Early Identification of Peripheral Neuropathy Using a Monofilament

Abstract

Purpose: The purpose of this quality improvement paper was to encourage the adoption of early identification of diabetic peripheral neuropathy with monofilament screening at a highly diabetic-populated clinic in Phoenix, Arizona. Background: Diabetes mellitus type 1 and diabetes mellitus type 2 affects individuals differently; diabetes implicates specific pathophysiology that characterizes itself as a b-cell dysfunction or destruction. Multiple comorbidities coexist with diabetes, one of them being diabetic peripheral neuropathy, increasing the possibility of complications related to ulcers, foot infections, and disabilities leading to amputations. Semmens Weinstein Monofilament is an easy-to-use, cost-effective tool that can be applied in the primary care setting to help identify diabetic peripheral neuropathy. Methods: The Plan-Do-Study-Act cycle was the chosen method. The design was a pre-survey with an in-service education session followed by a post-survey. Healthcare providers, staff members, and clinical management within the clinic participated in the educational session. Results: At American Family Medicine, pre-survey results exposed that 7 (78%) staff members had no experience with diabetic peripheral neuropathy screening tools, such as monofilament. It was also evident that there was no diabetic peripheral neuropathy screening protocol; six (67%) of participants reported “unsure,” two (22%) said “disagree,” and one (11%) reported strongly disagree with the question “do you believe that you have an effective diabetic peripheral neuropathy screening tool protocol at your clinic?” Post-survey results revealed that five (56%) participants strongly agreed, and four (44%) participants agreed that monofilament is a reliable screening tool to assess for peripheral neuropathy. Four (44%) participants agreed, and five (56%) participants strongly agreed to implement annual foot exams in future practice, and that monofilament is a reliable tool. Conclusions: There was generally a positive response post-educational in-service. Most staff members had not been previously exposed to diabetic peripheral neuropathy education, its risk factors, and screening tools for early identification. Since the in-service, American Family Medicine plans to provide education to their patients and implement annual foot exams as well as a screening tool for early identification of diabetic peripheral neuropathy.