1. • This project used the Stetler model of research utilization
framework to apply evidence-based findings to clinical settings
to improve screening in clinical practice for adults aged 18
years or older at risk of food insecurity.
• This evidence-based knowledge change of practice project
demonstrated how to be a DNP in 3 days
• The USDA defines FI as “limited or uncertain availability of
nutritionally adequate and safe foods or limited or uncertain
ability to acquire acceptable foods in socially acceptable ways”
(Anderson, 1990, p. 1,559).
Background
Intended Improvement/Purpose of Change
Phase 1 Preparation:
• Literature review to answer clinical question (PICCO)
• Among low income food-insecure adults with T2DM,
compared to current practice of not screening at risk
patients, will giving education sessions to healthcare
providers improve screening at risk patients for food
insecurity at the point of care from 0 %( baseline) to 50 %
within 3 months project period?
• SWOT analysis to identify potential barriers
Phase II Validation:
• Critique research to determine scientific relevance
Phase III:
• Comparative evaluation/decision making.
Phase IV:
• Translation/Application
Phase V:
• Evaluation
Planning the intervention
• Analysis of quantitative data, including assessment of changes to outcomes, was conducted using SPSS, version 17, with the level
of significance set at <0.05.
• Data for the project was imputed into excel Microsoft Excel spreadsheet and the quantitative data was analyzed using excels
functions, and descriptive statistics.
• Target population demographic characteristics at baseline and post-implementation were analyzed with percentages, means, and
standard deviations.
• Outcomes were extracted monthly via manual and electronic chart review by the author tracked monthly using diabetes chart audit.
• Bar graphs were used to show the improvement journey over the 3- months period.
Method: Analysis
Discussion
Relativity to Other Evidence
• 38 % of diabetics participants seen in a safety net clinic
reported difficulty access food (seligman)
• 61 % of diabetics participants in a safety net hospital
reported experiencing hypoglycemia (Nelson)
• 1/3 of the episodes was associated to lack of access to lack
of food
Interpretation
• The results of this project was interpreted as significant due
to the positive impact on diabetes outcomes in adults
earning low incomes and at risk of FI
Barriers to Implementation/Limitations
• Lack of time due to heavy caseload
• High provider turnover, financial barriers, Lack of dietician
or diabetic educator, Patient mix, Cultural barriers, High no
show rate
• One primary care clinic, Small sample size of providers and
patients
Lessons learned
• Formation of weak links in the organization,
• Forgetfulness, Busy providers and lack of time
• Education sessions provided to MAs on how to administer
the FI screening to patients resulting in time saving for
providers. Reminder alerts
Future Plan
• Integrate FI screening tools into EMR
Conclusions
Increase knowledge of food insecurity resulted in an absolute
increase of 82 % in Food insecurity screening from baseline
of 0 %.
• A1C < 7 % 18 % absolute change
• 70% at risk patients identified as positive for food insecurity
• A standard protocol was developed and implemented, based
on recommendations made in the literature.
• This project contributes important evidence that can be used
in clinical practice by advance-practice registered nurses.
Reference
• http://repository.usfca.edu/dnp/48
Aim:
To implement an evidenced based food insecurity screening
survey module in clinical setting .
Objectives:
• Improve providers and MAs knowledge.
• Standardized FI screening intervention algorithm protocol
• To increase the number of high-risk, low-income adults
with diabetes screened for food insecurity
• To increase the number of high-risk, food insecure, low-
income adults with diabetes receiving nutritional
counseling
Review of Evidence
• A systematic search of the following databases was
conducted: Cochrane, CINAHL, Pub Med, Science Direct,
Midline, and ProQuest.
• The quality and strength of each individual study was
appraised using JHNEBP Research Evidence Appraisal
Florence N Soba, DNP FNP-BC
University of San Francisco • DNP Comprehensive Project
2130 Fulton Street | San Francisco, CA 94117-1080 | (415) 422-5555
Implementation of Food Insecurity Screening in Clinical Setting
Conceptual/Theoretical Framework
• The plan–do–study–act (Institute for Healthcare Improvement
[IHI], 2014)
• Kurt Lewin’s change theory involves three stages the
unfreezing stage, moving stage, and refreezing stage.
• Stetler model of research utilization consists of a five-phase
process each phase was used as a guide in organizing the
literature review to answer clinical questions (Melnyk &
Fineout-Overholt, 2005).
Methods
Ethical issues:
• Non Research approval Obtained
Setting:
• Safety Net Clinic with FQHC status
• Team included providers, MAs, IT, CMO and
COO
Population:
• Adults aged 18 years or older diagnosed with
T2DM via retrospective electronic charts
• Intervention varied monthly, adjusted based upon
team feedback
• Data obtained by the team leader
• Excluded: patients < 18 years, patient diagnosed
with type I diabetes and gestational diabetes.
Results of Implementation of Food Insecurity Screening
0%
20%
40%
60%
80%
Positive FI Negative FI
70%
30%
Result of Food Insecurity Screening
May - July 2014