Original Research

Improving diabetic foot screening at a primary care clinic: A quality improvement project

Michelle L. Allen, Albertine M.B. van der Does, Colette Gunst
African Journal of Primary Health Care & Family Medicine | Vol 8, No 1 | a955 | DOI: https://doi.org/10.4102/phcfm.v8i1.955 | © 2016 Michelle L. Allen, Albertine M.B. van der Does, Colette Gunst | This work is licensed under CC Attribution 4.0
Submitted: 27 July 2015 | Published: 31 August 2016

About the author(s)

Michelle L. Allen, Division of Family Medicine and Primary Care, Stellenbosch University
Albertine M.B. van der Does, Division of Family Medicine and Primary Care, Stellenbosch University and Swartland Hospital, Malmesbury, South Africa
Colette Gunst, Division of Family Medicine and Primary Care, Stellenbosch University and Cape Winelands District, Western Cape Government Health

Abstract

Background: Foot screening is an important part of diabetic care as it prevents significant morbidity, loss of function and mortality from diabetic foot complications. However, foot screening is often neglected.
Aim: This project was aimed at educating health care workers (HCWs) in a primary health care clinic to increase diabetic foot screening practices.
Setting: A primary health care clinic in the Western Cape province of South Africa
Methods: A quality improvement project was conducted. HCWs’ needs were assessed using a questionnaire. This was followed by focus group discussions with the HCWs, which were recorded, transcribed and assessed using a general inductive approach. An intervention was designed based on common themes. Staff members were trained on foot screening and patient information pamphlets and screening tools were made available to all clinic staff. Thirty-two consecutive diabetic patient folders were audited to compare screening in 2013 with that in 2014 after initiation of the quality improvement cycle.
Results: HCWs’ confidence in conducting foot screening using the diabetic foot assessment questionnaire improved markedly after training. Diabetic foot screening practices increased from 9% in 2013 to 69% in 2014 after the first quality improvement cycle. A strengths, opportunities, aspirations and results (SOAR) analysis showed promise for continuing quality improvement cycles.
Conclusion: The findings showed a significant improvement in the number of diabetic patients screened. Using strategic planning with appreciative intent based on SOAR, proved to be motivational and can be used in the planning of the next cycle.

Keywords

diabetes; foot screening; quality improvement cycle; primary health care clinic; health care workers; quality improvement; diabetes foot care

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