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

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 AfricaMethods: 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.

FIGURE 1

The quality improvement cycle.

FIGURE 2

Klapmuts clinic staff questionnaire.

FIGURE 3

Diabetic foot assessment questionnaire developed by the Western Cape Department of Health.

FIGURE 4

Foot screening completed in 2013 and 2014 (total of 32).