Educating registered nurses to perform monofilament exams on type 2 diabetics to detect peripheral neuropathy

Abstract

Diabetic Peripheral Neuropathy (PN), a serious complication of diabetes, affects nearly 50% of diabetics. Complications of PN are pain, foot wounds, infection, and amputation of the lower extremity. These complications cost the healthcare system billions of dollars annually. Assessing for loss of sensation in the feet is an American Diabetes Association (ADA) standard of care. This exam is vital in preventing further complications and is done with a simple tool called the monofilament wire. Currently registered nurses are not educated in school or on the job on how to use this simple tool; therefore it is unknown how effective registered nurses could be at detecting PN. This study aimed to determine if registered nurses could be educated on the use of a monofilament tool and perform these exams accurately and obtain reliable results. Five registered nurses in an outpatient diabetes clinic were educated on how to perform a monofilament exam using recommendations by the ADA. The nurses performed practice exams on each other while being observed by the author. After successfully completing the education process they performed the exam on patients. The nurses performed 15 monofilament exams. A negative result indicates sensation in the feet is in tact. A positive indicates loss of sensation. The patient's primary care provider verified all 15 results obtained. The nurses' results were congruent 100% of the time when compared to the provider's. Of the 15 exams, 53% were positive and 47% were negative The results of this study indicate that nurses can be educated on how to perform the monofilament exam accurately, based on the verification of results by the primary care provider. Although a small sample size, the results show that the nurses picked up 53% of cases of loss of sensation, which will increase patient awareness and provide opportunity for education on foot health and how to prevent foot wounds and infections. Allowing the nurse to participate in this simple exam, as part of their assessment on diabetic patients, will increase the number of cases of PN detected, decrease costs to the healthcare system, and increase patient quality of life.