NURS FPX 9040 Assessment 2 Manuscript Secondary Review (Phase 4)

NURS FPX 9040 Assessment 2 Manuscript Secondary Review (Phase 4) Student Name Capella University NURS-FPX9040 Doctor of Nursing Practice 5 Professor Name Submission Date   Abstract Poor glycemic control among adults with type 2 diabetes in outpatient primary care reflects a significant practice gap, largely driven by inconsistent follow-up, limited patient education, and inadequate medication management. At the project site, 42% of patients had HbA1c >9%, and only 36% achieved <7%, exceeding national benchmarks of 22% of U.S. adults with diabetes experience poor glycemic control (Adjei et al., 2025; APRN, personal communication, November 2025). The guiding PICOT question was: For nursing staff caring for adult patients with diabetes (P), how does implementing the ADA diabetes follow-up protocol (I), compared to current practices (C), affect glycemic control (O) over 8 weeks (T)? The quality improvement project implemented a structured, ADA-aligned follow-up protocol over eight weeks in an outpatient primary care setting. The interdisciplinary implementation team included nursing staff and healthcare providers trained through structured educational sessions on diabetes management and EHR utilization. Adult patients with type 2 diabetes participated in bi-weekly follow-up visits. Evaluation included HbA1c measurements, visit completion rates, and adherence tracking using EHR-based tools. The intervention resulted in a clinically significant mean HbA1c reduction of 1.52 percentage points (from 9.95% to 8.22%), exceeding the predefined success threshold of 0.5%. Follow-up adherence was high, with 89.2% of visits completed. Despite improvement, only 10% achieved HbA1c <7% within eight weeks. The structured ADA follow-up protocol significantly improved glycemic outcomes, supporting the PICOT hypothesis. The project supports the sustainable integration of standardized follow-up protocols to enhance chronic disease outcomes in primary care. Keywords: Diabetes Management, HbA1c Reduction, Nurse-Led Intervention, Outpatient Primary Care, Quality Improvement, Follow-Up Protocol. Table of Contents Improving Glycemic Control in Adult Patients with Type 2 Diabetes Through Implementation of a Structured ADA Diabetes Follow-Up Protocol in an Outpatient Primary Care Setting. 5 Practice Problem.. 5 Project Site. 8 Project Population. 10 Evidenced-Based Interventions. 12 Role of the Project Lead. 16 Roles of Other Team Members. 17 Literature Synthesis. 18 Analysis of Evidence. 20 Theme 1: ADA Guideline Adherence and Clinical Practice Standards. 22 Theme 2: Nurse-Led Interventions and Staff Competency Development 24 Theme 3: Diabetes Self-Management Education and Support Interventions. 26 Theme 4: Technology-Enhanced Diabetes Care and Remote Follow-Up Protocols. 28 Synthesis of Findings. 30 Implementation Plan for the Intervention. 31 Conceptual Model 33 Data Collection and Analysis. 35 Ethical Considerations. 37 Project Results. 39 Project Outcomes. 40 Recommendations. 43 Summary. 44 Appendix A.. 58 Demographic Characteristics and Baseline HbA1c (N = 20) 58 Appendix B.. 60 HbA1c Outcomes Across Measurement Time Points (N = 20) 60 Appendix C.. 62 Follow-Up Adherence and Visit Completion Data (N = 20) 62 Appendix D.. 64 Nursing Staff Competency Assessment Results (N = 8) 64 Appendix E.. 65 Self-Management Behavior Checklist — Week 8 (N = 20) 65 Appendix F. 67 Summary Statistics: Project Implementation Outcomes. 67 Improving Glycemic Control in Adult Patients with Type 2 Diabetes Through Implementation of a Structured ADA Diabetes Follow-Up Protocol in an Outpatient Primary Care Setting Missed opportunities for diabetes education, medication review and preventable complications are linked to poor glycemic control among adult patients with type 2 diabetes mellitus in the outpatient setting of primary care, which is characterized by a lack of standardized, protocolized follow-up pathways. The number of adult patients with hemoglobin A1c levels greater than 9% at the project site and those who achieved the recommended target of less than 7% is much higher than the national averages, with approximately 22% of U.S. adults with diabetes having poor glycemic control (Adjei et al., 2025; APRN, personal communication, November 2025). Implementation barriers in nurse-led follow-up, staff competency, and structured patient education remain in primary care settings, despite the American Diabetes Association’s clinical practice guidelines. The PICOT question for the project is: For nursing staff caring for adult patients with diabetes (P), what is the effect of implementing the ADA diabetes follow-up protocol (I) compared to current practice (C) regarding glycemic control outcomes (O) for 8 weeks (T)? A structured follow-up process with the addition of staff competency building and patient self-management education will yield clinically significant improvements in glycemic outcomes and will further evidence-based chronic disease management in outpatient primary care. Practice Problem Outpatient primary care for chronic diseases should be systematic and evidence-based, and should help mitigate chronic diabetes glycemic outcomes that fail to meet health system benchmark standards. Data from the outpatient primary care clinic indicated a total of 42% of the adult population had hemoglobin A1c levels greater than 9%, with only 36% having hemoglobin A1c levels less than 7 percent (APRN, personal communications, November 2025). Within the national context, almost one-fifth of the adult population with diabetes has poor glycemic control, while almost one-half of all adults with diabetes around the world have not reached an HbA1c level of less than 7%, which highlights the site performance data and its significant improvements over benchmarked health system performance (Adjei et al., 2025; Dinavari et al., 2023). However, 1 in 4 adults in the U.S. and Europe still maintains an HbA1c level above 9%, indicating very poor metabolic control of the people (Gomes et al., 2022). There is a high level of consensus that in adults attending outpatient diabetes clinics, the most important cause of poor glycemic control is behavioural and demographic factors; the early identification of people at higher risk of having poor glycemic control is required, and the use of structured clinical intervention to improve glycemic control is important. (Karmakar et al., 2025) The quantitative data collected from the site help establish a measurable basis for a targeted quality improvement intervention at the practicum site. A comprehensive assessment of existing workflow and process flow, staffing, and coordination of care practices in the clinical setting is necessary to fully understand the causes that lead to suboptimal glycemic control. At the project site, auditing charts and documenting EHR identifies key process failures that are associated with suboptimal glycemic outcomes, including