Doctor of Nursing Practice Program

Rachel DeCoster, DNP, APRN, MSN

Rachel DeCoster
  • Committee Chair Name & Credentials:
    Jason Jean, DNP, RN, FNP-BC
  • Committee Member Name & Credentials:
    Queen Henry-Okafor, PhD, FNP-BC, PMHNP-BC


DNP Project Abstract

Evaluating the Impact of Hemoglobin A1C Point-of-Care Testing in a Primary Care Clinic 

HBA1C is the gold standard for measuring glycemic status, making it a critical component of diabetes management. Despite this, Winchester Medical Associates has been unable to reach organizational Comprehensive Diabetes HBA1C control metrics (82%). The specific aim of this practice improvement project was to increase HBA1C control metrics (74%) through revision and implementation of an existing HBA1C Point of Care (POC) standing order.

This project follows a mixed-methods approach which includes a focus group to identify facilitators and barriers to standing order development and implementation, followed by HBA1C POC standing order implementation, and finally, a post-implementation survey with focus group to discuss emerging themes from survey responses.

Following implementation, there was a 1% increase in Comprehensive Diabetes Quality Measures with nearly 22 patients achieving HBA1C goals. Pre-implementation survey responses revealed perceptions of prompt decision making and enhanced clinical outcomes but was opposed with concerns of extended patient-provider interactions. Post-implementation perceptions validated that 100% of respondents (n=12) found HBA1C useful, allowed for rich patient discussion opportunities, and was a model that could aid in achieving quality measure expectations.

Implications for Practice
POC standing orders improve clinical operations; increase patient, provider, and staff satisfaction; and provide an opportunity for healthcare provider discussions regarding treatment plans.