NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change
Phillip October 5, 2023 No Comments

NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change

NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change

Student Name

Capella University

NURS-FPX 6218 Leading the Future of Health Care

Prof. Name

Date

Change Proposal Summary Report

The main goal of this executive summary report is to propose a change in the management of peripheral neuropathy in diabetic patients in healthcare organizations within Colorado. For this purpose, intricate research on peripheral neuropathy is conducted, followed by a comparative analysis of its management in non-U.S. healthcare systems to find effective measures and strategies in change proposals so that the quality of health in people with diabetes is improved by reducing diabetes-associated complications of peripheral neuropathy.

Executive Summary

Proposed Change

Peripheral neuropathy is a challenging complication for patients with diabetes. It affects peripheral nerves, causing pain, sensory loss, and paraesthesia. Diabetic peripheral neuropathy (DPN) impacts 50% of diabetics resulting in pain with a risk of foot ulcers 25%, which can lead to leg amputation (Hicks & Selvin, 2019). Considering these consequences of poor care, strenuous efforts are required to promote aggressive screening and management of diabetes through regular HbA1c monitoring, foot examination, and pain management.

The local healthcare systems in Colorado have been facing peripheral neuropathy as an emerging problem for diabetics, where many patients suffer from numbness in their feet, pain, foot ulcers, and leg amputations. Considering this overwhelming condition of diabetic peripheral neuropathy impacting patients’ quality of life, it is essential to focus on changing this particular care area so people with diabetes can have improved health and quality of life. By addressing this specific issue and improving diabetes management through adequate foot examination at least once annually, as recommended by American Diabetes Association, peripheral neuropathy can be controlled (American Diabetes Association Professional Practice Committee, 2021). Furthermore, improving glycemic levels through lifestyle modification and pharmacotherapy can reduce the risk of peripheral neuropathy and its progression. Additionally, educating the patients on foot care and self-care behaviors to regulate glycemic levels will enable the delayed onset of peripheral neuropathy (Alahakoon et al., 2020).

Desired Outcomes

This proposal for improvement in diabetes patients with peripheral neuropathy through adequate foot examination, foot care and patient education will result in several desired outcomes that we aim to achieve through this proposal for change and improvement. These desired outcomes are as follows

  1. Prevention of neuropathy complications: By timely managing diabetes and peripheral neuropathy, one can prevent complications such as infections, delayed healing, foot ulcerations, and leg amputations in advanced cases of peripheral neuropathy (Selvarajah et al., 2019)
  2. Enhanced sensation: In peripheral neuropathy, the sensory peripheral nerves are damaged, affecting sensation to temperature, pain and pressure, causing numbness and tingling. By improving glycemic levels and preventing peripheral neuropathy, diabetics can have enhanced sensation to changes in physical stimuli that facilitate preventing injuries (Agarwal et al., 2019). 
  3. Improved mobility and preservation of limb function: Managing and preventing peripheral neuropathy through lifestyle modification and dietary changes to regulate glycemic levels promote mobility in people with diabetes and helps them balance and coordinate their gait while walking, which can be hindered by lower nerve power. Improved mobility will prevent risks of patient falls and helps people with diabetes stay active in their lifetime (Zilliox & Russell, 2019).

NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change

Achieving these outcomes requires stakeholders to pay for care and implement desired changes. For this purpose, healthcare organizations must have adequate resources to provide attentive care to people with diabetes regarding peripheral neuropathy, where adequate foot examinations are conducted, and nurses guide patients to self-care for their feet by regulating their blood glucose levels. Moreover, external resources such as Medicare and Medicaid programs of the Affordable Care Act that provide health insurance coverage for older people with chronic diseases and promote care delivery in low-income individuals are also potential sources (Duru et al., 2020).

Some factors that limit the achievement of these outcomes are the need for more human and financial resources, lack of adequate inter-professional collaboration and patient compliance. The optimal healthcare solutions to achieve these desirable outcomes include implementing inter-professional collaboration in delivering patient-centered care to manage diabetes in patients and training physicians and nurses on performing foot examinations properly. Additionally, providing effective foot care to avoid long-term complications of peripheral neuropathy is imperative (Aalaa et al., 2022). 

Health Care System Comparative Analysis

We have conducted a comparative analysis on managing and preventing peripheral neuropathy in two non-U.S. healthcare systems to gain broader knowledge and find a better approach. The National Health Service (NHS) healthcare system in the United Kingdom follows the guidelines provided by the National Institute for Health and Care Excellence (NICE), specifically about managing diabetes and associated complications of peripheral neuropathy. NICE recommends that healthcare organizations conduct regular foot examinations and promote patient education in people with diabetes on self-management and self-care feet to prevent peripheral neuropathy and the associated complications (NICE, 2019). NICE provides guidelines on the frequency of foot assessment for all age groups with diabetes, mainly focusing on adults with diabetes to assess feet on diagnosis and annual checkups or when foot problems arise.

NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change

Furthermore, it guides the investigation and treatment of foot ulcers, infections, and Charcot arthropathy. Another valuable healthcare system based in Australia follows the guidelines from the Australian Diabetes Society (ADS) which has a particular division on Diabetes Feet Australia (DFA). It provides comprehensive guidelines and strategies to manage foot care in diabetic patients. DFA offers educational webinars and events on foot care and preventive measures to delay peripheral neuropathy. Furthermore, it has recently launched digital DFA guidelines platforms where patients with diabetes can take guidelines for foot care digitally and daily foot care checklists (Diabetes Feet Australia, n.d.).

These two non-US-based health approaches towards peripheral neuropathy can guide the US healthcare system in implementing similar strategies to prevent foot complications due to peripheral neuropathy. In the local healthcare systems of Colorado, annual foot examinations for diabetics must be conducted, and physicians must be trained on evaluating and assessing foot diseases to provide appropriate and timely care treatments. Moreover, the US-based healthcare systems can develop educational events on foot care for people with diabetes to enhance their knowledge on peripheral neuropathy and the importance of foot care as created by Australian healthcare systems.

The Rationale for the Proposed Change

 These specific proposed changes can improve outcomes in diabetic patients in terms of peripheral neuropathy. Through adequate peripheral neuropathy prevention and management, as directed by NICE guidelines and DFA recommendations and strategies, patients with diabetes will have a longer life span with intact mobility and physical activity as their peripheral nerves stay intact. Moreover, lower limb amputation will be prevented as the regular monitoring of glycemic levels is conducted along with appropriate foot examination and care (Selvarajah et al., 2019). Furthermore, the proposed change will enable people with diabetes to self-care for their diabetes and foot by regularly finding foot-related symptoms and seeking medical care promptly.

Financial and Health Implications

Implementing proposed changes for preventing and managing peripheral neuropathy in people with diabetes can have potential financial and health implications. Timely prevention of peripheral neuropathy through proposed change can avoid the financial costs required to treat peripheral neuropathy and long-term rehabilitation. The cost-effective early screening, treatment and management reduce the financial burden on patients with diabetes and overall healthcare organization as fewer hospitalizations, surgeries and medical treatments (Rodríguez-Sánchez et al., 2019).

NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change

This will improve quality of life, enhance glycemic control, improve prognosis, and reduce the risk of foot problems. There are various financial and health implications if the proposed changes are not made timely. For instance, surgeries and medical intervention may be required to treat advanced peripheral neuropathy causing a financial burden on patients and healthcare organizations, followed by poor quality of life with reduced productivity due to impaired mobility (Kiyani et al., 2020).

Conclusion

This summary report highlights the peripheral neuropathy issue in diabetics, an emerging issue in the local healthcare systems of Colorado. For this purpose, a comparative analysis of preventing and managing peripheral neuropathy in the United Kingdom and Australian healthcare systems is conducted. This showed that healthcare systems in Colorado could implement similar strategies like mobile apps and peripheral neuropathy clinics to improve financial and health outcomes for diabetic patients with peripheral neuropathy.

References

Aalaa, M., Amini, M. R., Delavari, S., Mohajeri Tehrani, M. R., Adibi, H., Shahbazi, S., Shayeganmehr, Z., Larijani, B., Mehrdad, N., & Sanjari, M. (2022). Diabetic foot workshop: A strategy for improving the knowledge of diabetic foot care providers. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 16(7), 102543. https://doi.org/10.1016/j.dsx.2022.102543 

Agarwal, P., Sharma, B., & Sharma, D. (2019). Tarsal tunnel release restores sensations in sole for diabetic sensorimotor polyneuropathy. Journal of Clinical Orthopaedics and Trauma, 11(3). https://doi.org/10.1016/j.jcot.2019.08.014 

Alahakoon, C., Fernando, M., Galappaththy, C., Matthews, E. O., Lazzarini, P., Moxon, J. V., & Golledge, J. (2020). Meta‐analyses of randomized controlled trials reporting the effect of home foot temperature monitoring, patient education or offloading footwear on the incidence of diabetes‐related foot ulcers. Diabetic Medicine, 37(8), 1266–1279. https://doi.org/10.1111/dme.14323

Diabetes Feet Australia. (n.d.). Diabetes feet australia. https://www.diabetesfeetaustralia.org/  

Duru, O. K., Harwood, J., Moin, T., Jackson, N. J., Ettner, S. L., Vasilyev, A., Mosley, D. G., O’Shea, D. L., Ho, S., & Mangione, C. M. (2020). Evaluation of a national care coordination program to reduce utilization among high-cost, high-need Medicaid beneficiaries with diabetes. Medical Care, p. 58, S14–S21. https://doi.org/10.1097/mlr.0000000000001315 

NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change

Hicks, C. W., & Selvin, E. (2019). Epidemiology of peripheral neuropathy and lower extremity disease in diabetes. Current Diabetes Reports, 19(10). https://doi.org/10.1007/s11892-019-1212-8 

Kiyani, M., Yang, Z., Charalambous, L. T., Adil, S. M., Lee, H.-J., Yang, S., Pagadala, P., Parente, B., Spratt, S. E., & Lad, S. P. (2020). Painful diabetic peripheral neuropathy: Health care costs and complications from 2010 to 2015. Neurology: Clinical Practice, 10(1), 47–57. https://doi.org/10.1212/CPJ.0000000000000671 

NICE. (2019, October 11). Overview | Diabetic foot problems: prevention and management | Guidance | NICE. https://www.nice.org.uk/guidance/ng19

Rodríguez-Sánchez, B., Peña-Longobardo, L. M., & Sinclair, A. J. (2019). Cost-effectiveness analysis of the neuropad device as a screening tool for early diabetic peripheral neuropathy. The European Journal of Health Economics, 21(3), 335–349. https://doi.org/10.1007/s10198-019-01134-2  

Selvarajah, D., Kar, D., Khunti, K., Davies, M. J., Scott, A. R., Walker, J., & Tesfaye, S. (2019). Diabetic peripheral neuropathy: Advances in diagnosis and strategies for screening and early intervention. The Lancet Diabetes & Endocrinology, 7(12), 938–948. https://doi.org/10.1016/s2213-8587(19)30081-6 

Zilliox, L. A., & Russell, J. W. (2019). Physical activity and dietary interventions in diabetic neuropathy: A systemic review. Clinical Autonomic Research: Official Journal of the Clinical Autonomic Research Society, 29(4), 443–455. https://doi.org/10.1007/s10286-019-00607-x