Foot Examination Implementation with Monofilament in Primary Care: A Quality Improvement Project

Abstract

Purpose. This quality improvement project aimed to promote structured diabetic foot examination, promote compliance, and perform appropriate documentation at the American Family Medicine (AFM), Tolleson location. Background. Type 2 diabetes mellitus is a significant public health issue that affects over 37.3 million people nationally. The number is expected to grow exponentially as many are undiagnosed. In Arizona, there has been an increase of 10% from 2011 to 2016 with many more categorized as prediabetic. A common complication of diabetes is diabetic neuropathy which can contribute to life-threatening diabetic foot ulcers. Screening for loss of protective sensation with a 10-g monofilament can decrease mortality and morbidity associated with sequela of infections or amputations. Methods. Participants were clinicians and support staff at American Family Medicine, Tolleson. The Plan-Do-Study-Act (PDSA) cycle guided implementation. An in-service was provided, including evidence-based information regarding the purpose of a comprehensive diabetic foot exam, the use of monofilament, and participant roles/expectations for implementation. Data was collected via surveys post-in-service and after two weeks of implementation to evaluate change. Data analysis was analyzed using Microsoft Excel and reported with descriptive statistics. Results. The project implementation period was two weeks at AFM. The resulting evaluation responses indicate that the in-service improved knowledge and attitudes regarding utilization. Before implementation, there was no structured foot exam documentation or monofilament use. Post-implementation, all staff members providing direct care increased the use of structured foot exams with a monofilament tool. Conclusions. An annual foot assessment with a monofilament tool is an evidence-based screening tool that reduces complications such as ulcers and amputations among diabetic populations. It is also a cost-effective method for diagnosing loss of sensation and peripheral neuropathy and initiating conversation regarding the importance of foot care. An interdisciplinary approach is also beneficial when implementing this change.