Student Name

School of Nursing and Health Sciences, Capella University

NURS-FPX9020 Doctor of Nursing Practice 3

Professor Name

Submission Date

Slide 1

• VCI Summary 9020: Mid-Implementation Check Point

Hello, I am……. I am here to speak about a quality improvement project that I worked on to adapt the clinical practice guidelines of the American diabetes association to help enhance glycemic control of adult patients with type 2 diabetes at the project site.

Slide 2

• Introduction

Strategies to improve the quality of primary care are central to improving the care of people with chronic conditions and the outcomes of people who use primary care. Type-2 diabetes mellitus is a considerable burden of disease and is associated with cardiovascular diseases, neuropathy, and avoidable hospitalization (Siam et al., 2024). The results of the onsite findings showed that 42% of the adult patients who attended the outpatient primary care clinic had HbA1c readings above 9%, and only 36% had readings below 7%, which is a critical practice gap from national benchmarks (Adjei et al., 2025; APRN, personal communication, November 2025). Based on the American Diabetes Association guidelines (ADA 2024), interventions will include HbA1c testing, medication review, lifestyle counseling, and goal setting. The lack of a standardized and protocoled follow-up system resulted in variability in the delivery of education, medication reviews and glycemic control. The project leader used an evidence-based American Diabetes Association follow-up protocol with structured staff education to enhance glycemic control in adults with type 2 diabetes for 8 weeks.

Slide 3:

• Key Concepts

The quality improvement initiative is aimed at implementation of the follow-up protocol for the American Diabetes Association for adult patients with type 2 diabetes at the project site. This intervention, which consists of 8 weeks of structured follow-up with biweekly visits, nurse-led patient education, and telehealth support, provides individualized, evidence-based diabetes care that supports medication adherence, diabetes self-management, and reduces knowledge gaps and lifestyle modifications (Dailah, 2024). The nursing staff will undergo organized training for implementing the ADA guidelines, which includes adding competency to the training plan, incorporating simulation activities and peer mentoring with the training plan, and implementing EHR documentation as part of the training plan. During the intervention period, quality is implemented and continually improved using the plan-do-study-act (PDSA) model; PDSA provides a structured process to test workflow changes that can be assessed at a small scale over and over again (Lighterness et al., 2024). The primary results will include a decrease in the percentage of patients who have HbA1c levels above 9% and an increase in the overall competency and evidence-based diabetes care practices of nursing staff.

Slide 4

• Project Implementation

The implementation will take place over an 8-week systematic process of quality improvement (PDSA model) with a structured weekly plan to guide implementation and achieve all objectives and evidence-based protocols. The intervention will be well established with nursing staff in weeks 1-2, as they will be thoroughly collecting and presenting baseline data, preparing teaching materials and EHR dashboards relating to the Diabetes ADA post-discharge instructions. Weeks 3-4 are spent on formal staff education and beginning weekly patient follow-up visits (every two weeks), and the patient receives assistance with telehealth if they have mobility or access issues. Follow-up protocols with structured and guided instructions and nurse-led education have always shown clinically significant progression in glycemic control and staff competency in outpatient settings with chronic diseases (Yu et al., 2022). Standardized diabetes care pathways have also been demonstrated to tackle persistent care practice gaps through robust medication reviews, self-management education, and team-based follow-up across various patient cohorts (AlHaqwi et al., 2023). Continuous patient visits in weeks 5-6 will be biweekly; continuing diabetes care with telehealth; and each nursing staff member will have a competency evaluation in the middle of weeks 5-6 to assess adherence to the diabetes care protocol, with changes in teaching and learning strategies as needed based on formative assessment results. Week 7–8 will be dedicated to completing all of patient follow-up, checking process fidelity, interim and final outcome measures evaluation, and a comprehensive analysis of baseline and post-intervention data.

Slide 5

• Barriers

There will be several barriers to implementing the diabetes quality improvement project. Patient engagement is important, particularly for low health-literacy patients who haven’t developed positive digital technology habits for engagement. Variance in the competence of the baseline nursing staff leads to inconsistencies in the provision of standardised diabetes education in the interprofessional team. Typical challenges to the implementation of quality improvement in outpatient chronic disease settings include differing technology, staff resistance to changes in protocols, and competing patient needs that compromise adherence to quality improvement interventions (Samal et al., 2021). The mitigation strategies that need to be proactive to overcome the barriers are: Telehealth alternatives, frequent EHR audits, and repeated staff mentoring (Lee et al., 2025). Inadequate or erroneous documentation of EHRs can lead to data quality challenges and the inability to accurately track the outcomes over time. Limited patient numbers due to attrition or nonattendance may affect the power of the study and its ability to detect clinically significant differences in HbA1c results. Building leadership capacity over the long term and investing in the right resources are essential to address implementation challenges.

Slide 6

• Project Strengths

There are several strengths in the quality improvement project in diabetes that establish its viability, rigor, and sustainability. All interventions are in line with the existing guidelines of the American diabetes association, and the proposed project is based on these guidelines. The interprofessional team approach to care, with a nurse practitioner at the outpatient care clinic, is a natural means of follow-up that patients prefer, and does not require an organization to make any significant changes. Multidisciplinary, structured quality improvement efforts that utilize validated follow-up protocols and monitoring systems based on EHRs have consistently demonstrated a positive impact in terms of glycemic outcomes (Kirkland et al., 2023). Another strength of the intervention that is anticipated to help overcome health equity, patient engagement, and self-management barriers across different populations is the incorporation of telehealth systems, culturally adapted education, and peer mentoring (Rejas et al., 2025). The PDSA model is a systemic, repetitive model that enables a coherent improvement of the workflow and instructional practices depending on the formative assessment information. Standard competency assessments, audit templates in EH, R, and run charts would delay implementation and provide sound and accurate measurement of process and outcome indicators in implementation. Overall, the project is well structured, interprofessional collaboration has been utilized, and the project meets the national diabetes standards, making it a project that can be repeated and expanded to other regions to encourage the management of chronic diseases.

Slide 7

• Project Weaknesses

The diabetes quality improvement project has a few limitations which could reduce the generalizability and sustainability of the findings. The small number of nursing staff participants (eight to ten) limits the statistical power to detect a relatively wide range of clinically important changes in competency and glycemic levels. The practicum timeframe is short, so it is difficult to assess the sustainability of HbA1c improvements outside of the practicum time frame. Quality improvement projects are typically implemented in one outpatient unit with small and homogeneous staff groups, and may have limited external validity and generalizability to different clinical settings (Gumpili & Das, 2022). Besides, using self-reported patient engagement measures and the documentation of patients’ EHRs can cause measurement bias that can affect the measurement of outcome evaluation (Al-Sahab et al., 2023). Patient health literacy, socioeconomic status, and digital access also limit the ability of the various elements of telehealth to reach all patients equally.

Slide 8

• Project Opportunities

Meaningful opportunities exist to take valuable steps toward improving the management of chronic diseases beyond the practicum environment in the diabetes quality improvement project. The ADA follow-up protocol has been standardized and can be replicated in other comparable outpatient primary care settings with different community-based populations in urban settings. The potential for the reduction of long-term diabetes-related complications, hospitalizations, and associated healthcare costs from quality improvement initiatives to improve glycemic control with structured nurse-led follow-up protocols is great (Dailah, 2024). Standardized diabetes care pathways can be integrated into the daily workflow to provide ongoing interprofessional learning and collaboration among healthcare providers in primary care (Sze et al., 2025). Results could lead to a change in organizational policy, be used to measure performance in value-based care, and enhance the clinic’s ability to help mitigate persistent health disparities in vulnerable populations of diabetics. The project will also be disseminated via peer-reviewed publications, which will further place the project in the body of nursing literature and quality improvement literature as a meaningful contribution.

Slide 9

• Project Threats

The external threats of the diabetes quality improvement project have the potential to impact implementation fidelity and sustainability of the project. There may be a lack of continuity of the standardized follow-up protocol due to staff turnover and changing priorities in the outpatient care setting, which can threaten or compromise the ongoing development of nursing skills gained during training. Patients may drop out of the follow-up process due to socioeconomic instability, transportation challenges, or other health priorities, which can substantially compromise the accuracy of outcome measures and completion rates of follow-ups (Jones & Dolsten, 2024). Outpatient chronic disease external quality improvement projects continue to be at risk from changes in protocol maintenance due to organizational changes, resource limitations, and changing regulations. Telehealth reimbursement policies that change at a quick pace, as well as digital infrastructure constraints, also continue to pose a risk to equitable access to follow-up components of telehealth interventions that are provided virtually (Lee et al., 2025). In addition, the issues of general public health disruption and competing institutional priorities may take leadership time and money away from maintaining the diabetes quality improvement efforts beyond the practicum.

Slide 10

• Expected Outcomes

The diabetes quality improvement project expects to see several measurable outcomes that will be clinically and process-oriented improvements over the 8-week implementation timeframe. The most important anticipated result is a clinically significant improvement in the percentage of adult patients with HbA1c levels >9%, with a goal of 70% or more of the patients enrolled to reach individual glycemic goals after a structured protocol of ADA follow-up. Significant improvements in competency scores for the nursing staff are other secondary outcomes, as a minimum competency of 80% was reached following the intervention using both simulation-based training and peer mentoring. Nurse-led interventions that are structured and follow a set of guidelines have been shown to have clinically significant decreases in HbA1c levels and sustained changes in patient self-management behaviors in a variety of outpatient primary care settings (Dailah, 2024). Increased competency in standardized diabetes follow-up procedures is significantly linked to better glycemic control, lower rates of complications, and higher likelihood of evidence-supported chronic disease management practices (Hessler et al., 2022). Process outcomes consist of more than 80% adherence to the scheduled biweekly follow-ups, >90% accuracy in filling out the fidelity checklist, and adherence to EHR documentation requirements throughout the implementation. The overall project goal is to develop a sustainable, replicable diabetes care model to enhance interprofessional collaboration and promote long-term diabetes control at the practicum site.

Slide 11

• Conclusion

The diabetes quality improvement project is a structured, evidence-based project designed to address the gaps in glycemic control of adult type 2 diabetes (T2DM) in the project area. Significant changes in the levels of HbA1c and the standardized level of care delivery will be achieved through the project, improving the competency of the nursing staff, and through the PDSA model-based constant quality improvement. However, despite the identified barriers, weaknesses, and threats, the interprofessional design, the incorporation of telehealth, and culturally-based education of the project are meaningful opportunities to make a sustainable difference. Finally, the project promotes the management of chronic diseases based on evidence and creates a framework that can be implemented in other similar primary care practices to enhance the long-term outcomes of diabetes.