Date of Award

Spring 5-25-2023

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Pedro Colio, PhD, DNP, FNP-C, ENP-C

Abstract

Background: Peripheral artery disease (PAD) is a prevalent chronic vascular disease that remains often underdiagnosed and inadequately treated. The development of PAD increases both with age and with the presence of modifiable and non-modifiable risk factors. Risk factors for PAD include smoking, diabetes, hypertension, hyperlipidemia, and chronic kidney disease. Furthermore, PAD can be an indicator of systemic atherosclerosis which is associated with coronary artery disease, carotid stenosis, and cerebrovascular disease. Undiagnosed obstructive PAD contributes to damaging atherosclerotic sequelae such as claudication, ulcers, infections, peripheral neuropathy, and amputations. It is common for PAD to exist in the absence of symptoms; therefore, providers should prioritize the screening of patients with known risk factors. Purpose: The aim of this evidence-based project was to introduce the American Heart Association/American College of Cardiology (AHA/ACC) standardized ABI screening statement to improve patient outcomes in an outpatient cardiology center by screening high risk asymptomatic patients utilizing the ankle-brachial index (ABI). According to the AHA/ACC, when ABI is used to assess high-risk asymptomatic patients then risk factor mitigation such as lifestyle modifications and pharmacological treatment can be implemented. This retrospective- prospective project compared the frequency of ABI ordering pre/postintervention and collected pertinent demographics (e.g., risk factors, symptoms, physical examination findings, and ABI screening results). Results: The results will demonstrate that the implementation of ABI screening protocol resulted in a statistically significant increase, by 31.6%, in the frequency of ABI ordering for patients that presented with physical signs and symptoms (e.g., lower extremity discoloration, hair loss, or paresthesia). Although provider-usage of ABI screening for asymptomatic patients did not significantly increase, postintervention ABI orders saw a 15% increase when compared to pre-intervention ABI orders. Conclusion: With integration into clinic policies, this project can be adapted to other outpatient cardiac centers using the AHA/ACC standards for ABI screening.

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