Date of Award

Spring 5-27-2023

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Joseph Burkard, DNSc, CRNA, AACN Health Policy Fellow


Purpose: The purpose of this evidenced based project was to implement an evidenced based peripheral artery disease screening protocol in an outpatient internal medicine clinic serving adult patients with multiple co-morbidities. This clinic inconsistently screened patients for PAD using the ankle-brachial index (ABI).

Methods: During a three-month period, 50 patients were screened using current American Heart Association and American College of Cardiology (AHA/ACC) screening guidelines for PAD using the Ankle-Brachial Index (ABI) and the Edinburgh Claudication Questionnaire (ECQ).

Results: Out of the 50 patients screened for PAD, only one patient (2%) had a normal ABI score (1.0-1.4) and was categorized in group two of the AHA/ACC risk groups. In group one, 16 patients (32%) had a borderline ABI score (0.8-1.0), group two had 23 patients (46%) with a borderline ABI score, and group three had two patients (4%) with a borderline ABI score. Finally, group one had two patients (4%) with abnormal ABI scores (0.5-0.8), group two had six patients (12%) with abnormal ABI scores, and group three had none. Seven patients scored a positive ECQ and six of these patients (12%) were categorized in risk group two, and the single remaining patient (2%) with the positive ECQ score was categorized in risk group one.

Evaluation: The project was done within a 3-month timeframe, which prevented follow up measurements of ABI scores in patients at risk of developing PAD. The short duration also prevented long term measurement of outcomes in patients who had decreased ABI scores requiring referral to a vascular specialist. Future projects could include outcome measurements of those requiring referral, and those whose risk factors were addressed.