Increasing Ophthalmology Referrals for Early Detection of Diabetic Retinopathy

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Thomas, Heather

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Diabetes mellitus currently afflicts 1 out of every 10 residents of North Carolina (North Carolina Department of Health and Human Services, 2016). Diabetic retinopathy (DR) is a distinct vascular complication of diabetes mellitus. Evidence reinforced the need for regular screenings to detect this condition in patients with diabetes mellitus because its initial stages are asymptomatic (American Diabetes Association, 2018). A Doctor of Nursing Practice (DNP) quality improvement (QI) project was implemented in a primary care clinic in rural North Carolina in an effort to increase the number of provider-given ophthalmology referrals to their patients with diabetes mellitus. Primary care providers and their clinical staff were educated on the use of the evidence-based teach-back method of providing patient instructions to increase awareness of the vision threatening complications of diabetes mellitus and the importance of yearly dilated eye exam screenings. The QI project was implemented over 8-weeks, with the DNP student project leader making weekly visits to the clinic to gather data and evaluate progress. Progress was evaluated using the Plan, Do, Study, Act (PDSA) Rapid Cycle of Improvement. A total of 178 charts were reviewed to evaluate the number of ophthalmology referrals given to patients with a diagnosis of diabetes mellitus. Results suggest that using the teach-back method to provide patient education assisted in prompting providers to give ophthalmology referrals when compared to referral occurrences prior to the use of the teach-back method of patient instruction.