MSN-FPX6021 Assessment 2 Change Strategy and Implementation Paper

Change Strategy and Implementation

Healthcare environments vary, and various strategies have varying degrees of success in promoting safety and enhancing quality and equitable care. Healthcare professionals review current data and utilize their skills and knowledge to remedy problems in the selected settings. Infection rates in diabetes are relatively higher in diabetic patients, and so are infection-related deaths secondary to diabetes. This essay reviews the burden of diabetes and proposes strategies to manage diabetes in primary care settings.

MSN-FPX6021 Assessment 2 Change Strategy and Implementation Paper




Data Table

Current Outcomes Desired outcomes Strategies

The current poor outcomes in healthcare settings, according to AHRQ, are:

·       Individuals have inadequate glycemic control, leading to a high risk for infection (Verstraeten et al., 2020).

       Individuals with diabetes have high rates of infections (About six percent of all infections) (Carey et al., 2018).

·       There are high rates of diabetes infection-related deaths (about 12% of the total infection-related deaths) (Carey et al., 2018)

The desired outcomes, according to the AHRQ, are:

·       Individuals’ FBS and RBS measures remain within acceptable limits (RBS below 180md/dl, and FBS 80-130mg/dl according to ADA) (ADA, n.d.)·       Individuals do not get infections secondary to diabetes

·       Decreased mortalities from infections in diabetic individuals

Effective strategies that could lead to the desired outcomes include:a). The first strategy is patient education that focuses on;

·       Advocating for vigorous glycemic controls through diet and exercise besides medications (ADA, n.d.)

·       Increase individuals’ awareness of diabetics and the high risk for infection

b). Advocate for Influenza and Pneumococcal vaccines in diabetic patients (Verstraeten et al., 2020).

c). Advocate for increased patient follow-up and adherence to the recommended routine tests and exams by the AHRQ (eye and foot exams and HbA1c tests) (Ernawati et al., 2021).

Infection in Diabetes

The burden of diabetes and diabetes complications is deeper than often perceived. Diabetes and infections have interrelations, and each condition worsens the other. Studies also show that diabetes complicates the management of virtually all chronic conditions through poor infection management (Carey et al., 2018). Significant complications are diabetic foot and peripheral and eye neuropathies, hypertension, and cerebrovascular accidents. A major silent killer is infections in diabetic patients. High blood sugar is common in diabetes mellitus, and low immunity increases the risk of developing notorious infections even with less virulent microorganisms (Kim et al., 2019).

Infections further complicate diabetes management, including gangrenous cholecystitis, foot infections, malignant external otitis, and rhinocerebral mucormycosis (Carey et al., 2018). Some studies claim that infections are the major cause of death in diabetes and diabetes complications. Existing evidence from a large, well-structured retrospective study in primary care revealed that diabetes accounts for about 6% of infection-related hospitalizations and about 12% of all infection-related mortalities (Zoppini et al., 2018).

The major causes of infection-related mortalities in diabetes are septic arthritis, osteomyelitis, septicemia, and cellulitis (Zoppini et al., 2018). High levels of blood sugar are the primary cause of poor prognosis. Most of these infections are found in areas with poor blood circulation, such as the bone and joints. Blood supply to the skin and the most affected organs is low, and they also have poor penetration of antibiotics, hence the severity of illnesses (Akash et al., 2020).

Infections and diabetes have complex relationships that require keen considerations to minimize the high prevalence and mortalities of diabetes. Glycemic control carries a huge weight in managing these infections, and healthcare providers should ensure they develop effective change strategies in their respective healthcare institutions (Carey et al., 2018).

Change Strategies, Justification, and Quality Improvement

To achieve the desired quality outcomes, several strategies should be implemented. Comprehensive diabetes infections awareness through diabetes education, empirical antibiotic choices, influenza and pneumococcal vaccines, and routine monitoring and referral of complicated cases are vital strategies for managing diabetes-related infections (Akash et al., 2020; Carey et al., 2018). The empirical antibiotic choice is a complex strategy that requires the input of pharmacists, nutritionists, nurses, and doctors and requires higher-order functions in organizations. Thus, it will not be included in our change strategies.

Comprehensive patient education is a vital strategy in this situation. Most individuals are unaware of the complications, and the information provokes perceived severity and susceptibility and promotes health self-care behavior (Luk et al., 2019). Existing evidence on patient education shows that education increases patient knowledge, promotes self-care practices (such as increased hospital visits), and changes therapeutic outcomes (such as HbA1c, RBS, and FBS) (Ernawati et al., 2021; Ghisi et al., 2021).

Education promotes equitable care through knowledge and self-care skills and the availability of resources to manage their health. Education helps individuals perform self-assessments, determine their problems, and seek healthcare for them. Illiteracy is the leading cause of the under-utilization of healthcare services (Carey et al., 2018). For example, knowledge of the severity of diabetic foot may provide individuals to seek healthcare services when they get any leg injuries. Thus, education will improve the quality of care they receive and

Vaccinations offer protection from common diseases that have severe morbidity and mortality. Influenza and pneumococcal infections are notorious infections that could lead to potentially fatal health effects. These vaccines reduce the susceptibility of diabetic individuals, reducing the rates and mortalities from infections in diabetes (Verstraeten et al., 2020).

Pneumococcal infections account for more than half of the fatal infections in diabetes. These vaccines are recommended, but the governing bodies hardly emphasize them, thus their low implementation rates. Developing an institutional policy for the uptake of these vaccines is therefore vital for the health of diabetic individuals. The adherence rates are relatively low due to the lack of a clear structure and follow-up on these vaccines (Verstraeten et al., 2020).

Individual differences in care delivery are vital, and providing these vaccines is critical in protecting individuals. Immunization protects individuals from preventable severe diseases and thus improves their quality of life and ability to manage their illnesses. Promoting their utilization will reduce the infection rates and associated mortalities and morbidity, hence better-quality care.

Routine visits are vital for diabetes management. The Agency for Health Research and Quality healthcare quality and disparities report recommends at least one diabetic foot exam, eye exam, and HbA1c test yearly (AHRQ, 2019). HbA1C tests are an important measure in determining an individual’s glycemic control activities effectiveness over time, unlike random blood sugar (RBS) and fasting blood sugar (FBS) tests, which show the immediate blood sugar state (ADA, n.d.).

The HbA1c tests reflect the effectiveness of diet, exercise, and medications and thus inform the clinical decision-making process to produce quality healthcare decisions. These visits help determine the effects of diabetes and the effectiveness of glycemic controls to inform management. The routine visits also help monitor the progress of existing complications and thus aid in the referral of complex cases to decrease associated mortalities and morbidities. Eye and foot complications are the most diabetes complications and indicators of underlying conditions.

Diabetes affects the microvascular structures of vital organs, and it is a leading cause of blindness in diabetic patients, especially the elderly (Mendez et al., 2021). Diabetic foot indicates underlying peripheral vascular neuropathies and is often associated with loss of sensations in plantar and dorsal foot surfaces. The results are the painless progress of the disease. Infections complicate diabetic foot, and due to poor circulation and wound healing in diabetes, they lead to necrosis, gangrene, and subsequent amputations due to complete loss of function.

All infections in diabetes follow a similar sequela; hence, the high rates of septicemia, septic arthritis, osteomyelitis, and diabetic complications can be avoided early through early diagnosis and referral for complex care (Zoppini et al., 2018). In addition, they can be avoided through vigorous education, leading to effective glycemic controls, and thus, the strategies are interdependent.

Change Strategies and Interprofessional Considerations

The change strategies mentioned will require interprofessional collaboration for holistic patient management and the achievement of quality patient outcomes. The interprofessional team inputs will be vital in the planning, implementing, and evaluating these interventions. Planning education to improve awareness and promote adherence to follow-up visits will require information from other healthcare professionals to aid in its success (Ernawati et al., 2021). The healthcare informatics team, nurses, and doctors will collaborate to plan comprehensive education.

They will assist manage change and enhance buy-in from all stakeholders. Involving interprofessional will improve holistic interventions that do not affect the patients anyway. During the education sessions, patients and care providers work together to achieve the desired outcomes. The timing of the vaccination will require deliberations from healthcare providers to determine the best time to implement them (Verstraeten et al., 2020). The American Diabetes Association (ADA) recommends these vaccines but does not give clear instructions on when the vaccine should be given to diabetes patients.


Diabetes is a complex chronic condition with high healthcare costs, as seen above. Diabetes and infections have a complicated relationship, with each worsening the other. Infections in diabetes are a leading cause of death. Diabetes complications such as diabetic foot are exacerbated, and infections make their management difficult. Comprehensive patient education increased patient follow-up/ routine visits, and influenza and pneumococcal vaccines are strategies to minimize these infection rates. Healthcare providers should be collaborative to enhance the success of these initiatives.

MSN-FPX6021 Assessment 2 Change Strategy and Implementation Paper References

  • Agency for Healthcare Research and Quality (AHRQ, 2019). 2019 National Healthcare Quality and Disparities Report.
  • Akash, M. S. H., Rehman, K., Fiayyaz, F., Sabir, S., & Khurshid, M. (2020). Diabetes-associated infections: development of antimicrobial resistance and possible treatment strategies. Archives of Microbiology, 202(5), 953–965.
  • American Diabetes Association (ADA) (n.d.) Understanding A1C Diagnosis.
  • Carey, I. M., Critchley, J. A., DeWilde, S., Harris, T., Hosking, F. J., & Cook, D. G. (2018). Risk of infection in type 1 and type 2 diabetes compared with the general population: a matched cohort study. Diabetes Care, 41(3), 513–521.
  • Ernawati, U., Wihastuti, T. A., & Utami, Y. W. (2021). Effectiveness of diabetes self-management education (DSME) in type 2 diabetes mellitus (T2DM) patients: Systematic literature review. Journal of Public Health Research, 10(2). 
  • Ghisi, G. L. D. M., Seixas, M. B., Pereira, D. S., Cisneros, L. L., Ezequiel, D. G. A., Aultman, C., Sandison, N., Oh, P., & da Silva, L. P. (2021). Patient education program for Brazilians living with diabetes and prediabetes: findings from a development study. BMC Public Health, 21(1), 1-16.
  • Kim, E. J., Ha, K. H., Kim, D. J., & Choi, Y. H. (2019). Diabetes and the risk of infection: a national cohort study. Diabetes & Metabolism Journal, 43(6), 804-814.
  • Mendez, I., Lundeen, E. A., Saunders, M., Williams, A., Saaddine, J., & Albright, A. (2022). Diabetes Self-Management Education and Association with Diabetes Self-Care and Clinical Preventive Care Practices. The Science of Diabetes Self-Management and Care, 26350106211065378.
  • Verstraeten, T., Fletcher, M. A., Suaya, J. A., Jackson, S., Hall-Murray, C. K., Scott, D. A., Thoma, B. S., Isturiz, R. E., & Gessner, B. D. (2020). Diabetes mellitus as a vaccine-effect modifier: a review. Expert Review of Vaccines, 19(5), 445–453.
  • Zoppini, G., Fedeli, U., Schievano, E., Dauriz, M., Targher, G., Bonora, E., & Corti, M. C. (2018). Mortality from infectious diseases in diabetes. Nutrition, Metabolism and Cardiovascular Diseases, 28(5), 444-450.

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