Date of Doctor of Nursing Practice Project Completion

2026

Faculty Advisor

Nancy Crider

Abstract

Abstract

Purpose: The purpose of this quality improvement project was to improve adherence to standardized diabetic retinopathy screening among adults with diabetes at an outpatient optometry practice in the Greater Houston area.

Background: Diabetic retinopathy (DR) is a leading cause of preventable blindness among adults in the United States. The American Diabetes Association recommends annual dilated eye examinations for all patients with diabetes; however national adherence rates remain at only 50–60%.

Methodology: A 12-week quality improvement initiative was implemented using the Plan-Do-Study-Act model. Interventions included staff education, EHR prompts for the diabetic eye-care protocol, pre-visit identification of patients with diabetes, patient education pamphlets, digital retinal imaging, standardized documentation, and referral tracking.

Results: Post-implementation results demonstrated an increase in retinal screening rates from approximately 60% (in which 57 diabetic patients from a total of 97 chose retinal imaging) pre-implementation to 74% (in which 23 diabetic patients from a total of 31) selected yes for retinal imaging compared to 8 who declined. Additionally, diabetic retinopathy documentation was maintained at approximately 98%, while referral rates to ophthalmology reached 100% for all patients (8 patients) who met the criteria outlined.

Implications: A standardized, team-based diabetic retinopathy screening protocol can strengthen preventive eye care in outpatient optometry practice. Integrating EHR prompts, staff education, patient education, retinal imaging, and referral tracking into routine workflow may improve screening reliability and support earlier detection.

Keywords

Diabetes, retinopathy, DR, optometry

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