| Description |
Diabetes currently affects 25.8 million people in the United States and is the seventh leading cause of death in the United States (Centers for Disease Control and Prevention, 2011). Moreover, it is a major cause of heart disease, stroke, kidney failure, impaired sensation of pain in hands and feet, erectile dysfunction, non-traumatic lower limb amputations, and new cases of blindness among adults (Centers for Disease Control and Prevention, 2011). The number of people with diabetes increases each year and the disease is being diagnosed earlier in life (Vivian, Carrel, & Becker, 2011). According to the literature, diabetes is a chronic condition affecting people in every social stratum. Low socioeconomic status is associated with higher prevalence of diabetes, decreased access to care, and a decreased likelihood of receiving recommended services (DeVoe, Tillotson, & Wallace, 2009; Wilper et al., 2008). Clinical guidelines promote preventative practices, guide providers in giving optimal care, and allow provides to make better informed, evidence-based decisions about diabetes care (Green, Gazmararian, Rask, & Druss, 2010; Walker, Engel, & Zybert, 2001; Zulkowski & Coon, 2005). Flow sheets coordinate and improve continuity of care between providers and increase the likelihood of receiving recommended clinical guideline cares (Porterfield & Kinsinger, 2002; White, 2000). This project addressed the underutilization of the diabetes flow sheet at the Doctors' Volunteer Clinic (DVC) in St. George, Utah through implementation a new diabetic flow sheet. This was accomplished through the following objectives: 1) educate staff and volunteer providers about the new "Diabetic Flow Sheet"; 2) implementation of the new flow sheet for all patients with diabetes; 3) compare the utilization of the new flow sheet compared to the old flow sheet; 4) modify the flow sheet based on provider's recommendations. Education of the staff and volunteer providers was accomplished through a five minute power point presentation at a staff meeting and voice over power point presentation, of which over 73% of providers were able to participate. At the request of the clinical director, the new flow sheet was placed in 75 patient charts that had been seen from November 2012 to February 2013. Pre-implementation chart review showed that 85.29% of old flow sheets that were present in the charts were being used. Post-implementation chart review showed that 57.69% of the new flow sheets placed in the charts were being used. The decreased use of the flow sheet may be due to lack of time for patients to return to the DVC to receive recommended cares. Only half of the key assessment factors which included weight, Body Mass Index (BMI), home glucose range, blood pressure, and if patient is on aspirin, angiotensin-converting-enzyme inhibitors, or angiotensin receptor blockers were documented. A questionnaire was constructed for providers to evaluate helpfulness and easiness, as well as suggested changes of the new flow sheet. Providers found the flow sheet helpful and easy to follow. No recommendations on how to improve the flow sheet were made. In conclusion, flow sheets provide an easy access tool for providers, ensuring that such guidelines are followed. The results of this project suggest that providers do not always utilize flow sheets even though they state they find them useful. Therefore, future work should identify barriers to the use of flow sheets by clinic providers. |
