Implementing Foot Care Program in a Rural Clinic
The prevalence of type 2 diabetes mellitus and its complications have increased in the United States (U.S. in recent years. Patients with diabetes have a higher risk of foot ulcers due to diabetic peripheral arterial disease accelerated by the direct damage to the nerve and blood vessels in lower extremities by high blood sugar. Foot amputations, and frequent hospital admissions due to these and other diabetes complications are also increasing. Healthcare providers' have a unique opportunity to prevent these complications and hospital admissions, and to promote patient wellness and physical well being through the provision of timely education and direct screening of patients' feet. Salud Para La Gente (SPLG) Clinic is one of the main clinics in the Watsonville area that provides care to 27,000 patients with chronic diseases annually. The SPLG Clinic education for patients with diabetes focuses on diet and pharmacotherapy but lacks foot screening and foot care education to patients. The literature review (Woodbury et al. Sibbald, Ostrow, Persaud, Lowe, 2015; McCulloch, 2018; Singh, 2015) clarifies that foot screening is an inexpensive preventative measurement and educating providers on the importance and use of the Simplified 60 Second Foot Screening Tool (shown in appendix 8) during a patient's visit reduces the rate of foot ulcers, re ulcerations, and foot amputations. The evidence shows that when clinicians take a short period of time to assess patients' feet and educate patients on foot care during a visit, foot ulcers can be treated early or prevented entirely, and patients' motivations to engage in their self care increases (Sharoni, Rahman, Minhat, Ghazali, Ong, 2017) This DNP student led quality improvement project involved an educational intervention for primary care providers. A pre survey was done before giving the education on foot screening IMPLEMNTING FOOT CARE PROGRAM IN A RURAL CLINIC 5 and care to measure the clinicians' level of knowledge. The survey also assessed the clinicians' performance of foot screening according to guidelines, strategies for helping diabetic patients on self foot care, and barriers to foot screening. An educational presentation was given, and a postsurvey was obtained. Increased level for knowledge, the difficulty of the education for providers and patients, likelihood of educating patients and passing on the brochure to a patient, the appropriateness of length, presentation quality, content level, and overall workshop quality were assessed in the post survey. The result showed providers were eager to use the evidence based screening tool, and clinicians' knowledge of foot care increased dramatically. They were excited to educate patients on foot care and foot log which is a diabetes self management log and help patients to keep track of their foot care daily. Appropriate educational approaches for patients with type 2 diabetes on foot care and providers on the Simplified 60 Second Diabetic Foot Screening Tool improve patients' outcomes, promote patients' quality of life in mental and physical aspects, and increase patients' diabetes management ability.