Date of Graduation

Fall 12-8-2014

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions



First Advisor

Dr. Robin Buccheri

Second Advisor

Dr. Mary Lou De Natale

Third Advisor

Dr. Jo Loomis


Ten percent of the National Health Service annual budget goes to treat complications from diabetes (Lancet, 2010). The American Diabetes Association® (ADA, 2013) estimated that diabetics in the United States incur $176 billion annually in direct medical costs for treatment with hospitalization being the main component of the expenditures. California has the largest population of diabetics and the highest annual cost at $27.6 billion (ADA, 2013). The Healthcare Cost and Utilization Project (HCUP, 2008) found that the average cost of hospitalization in 2008 for a patient with diabetes was $10,937 in contrast to $8,746 for a patient without diabetes. The Centers for Disease Control and Prevention (CDC, 2011) estimated that by 2050, one in three adults in the United States will develop type II diabetes. This DNP student was inspired by the Institute of Healthcare Improvement’s (IHI) (IHI, 2013a) Triple Aim (see Appendix A). The IHI Triple Aim is a three dimensional improvement system that aims for better health care and lower cost for patients with complex needs (IHI, 2013a).This DNP student designed and took the lead as project manager to implement a quality improvement (QI) project to provide streamlined care to type II diabetic patients, saving healthcare provider’s time, and enhancing coordination of care between all specialty disciplines caring for these patients. This change in practice project employed an evidence-based practice diabetic flow sheet (EBPDFS) for staff that care for the adult type II diabetic patients at Samaritan House clinics in California. The goal of this pilot project at San Mateo Samaritan House was to have staff accurately utilize the flow sheet. After pilot completion, a staff survey provided valuable feedback and recommendations for improvements necessary prior to expansion of the project to the Redwood City Samaritan House clinic.