Date of Award

Spring 5-21-2016

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Dr Jonathan Mack

Second Advisor

Dr Sue Hoyt


The purpose of this evidence based practice (EBP) project was to evaluate an electronic medical record (EMR) based American Diabetes Association pre diabetes screening protocol in a primary care setting. Pre diabetes is an under screened condition that can result in a diagnosis of diabetes mellitus and the risk is 56% lower for those who had returned to normal glucose regulation versus those who consistently had pre diabetes. Patients with a body mass index (BMI) greater than 25 were flagged in the EMR at intake. Providers assessed for a previous HbA1C within the last year, if a HbA1c had been ordered an EMR reminder was placed for annual screening. If a HbA1c had not been ordered, an order was placed for a HbA1C and an EMR reminder was placed in the chart for annual screening. Eighty patients were flagged for screening and 21% were screened with a HbA1C at the time of the visit which was not an improvement over previous months screening rates. Of the patients who had labs ordered at the visit for other reasons, 55% had an HbA1c added onto visit related blood work. Of the labs returned, 43% of the patients were found to be pre diabetic. Utilizing the EMR to identify patients at risk for pre diabetes allows for consistency across providers in a clinic and for program sustainability. There was still a substantial missed opportunity to screen for pre diabetes which results in a potential $863,100 annually in diabetes related costs.