Aligning the Total Neuropathy Score (TNS) Project with Organizational Mission and Quality Improv ...
Aligning the Total Neuropathy Score (TNS) Project with Organizational Mission and Quality Improvement. Diabetes mellitus continues to be one of the leading causes of preventable complications, including diabetic peripheral neuropathy (DPN), which significantly affects patients' quality of life and increases the risk of falls, foot ulcers, infections, and lower-extremity amputations. Despite the availability of evidence-based screening recommendations, diabetic neuropathy often goes undetected until symptoms become advanced. This practice gap represents the foreground clinical issue that my Doctor of Nursing Practice (DNP) project seeks to address. Specifically, my project focuses on implementing the Total Neuropathy Score (TNS) as a standardized screening tool to improve the early identification and management of diabetic peripheral neuropathy among adult Hispanic patients receiving care in a primary care clinic. The organization where this project will be implemented is committed to delivering high-quality, patient-centered, culturally competent, and evidence-based healthcare services. The clinic's mission is to provide accessible, compassionate, and comprehensive care that improves the health and well-being of the community it serves. Its vision is to become a trusted leader in primary care by promoting innovation, clinical excellence, prevention, and continuous quality improvement. These organizational values emphasize proactive disease management, preventive care, and improved health outcomes, making the implementation of the TNS highly consistent with the clinic's strategic priorities. The proposed project aligns closely with the organization's mission by promoting early detection of diabetic peripheral neuropathy through a standardized and evidence-based assessment process. Rather than waiting until patients present with severe symptoms or complications, implementing the TNS encourages earlier clinical intervention and individualized management. This proactive approach supports patient-centered care by helping providers identify neuropathic changes sooner, educate patients about foot care and self-management, and initiate timely referrals or treatment when indicated. Early identification has the potential to reduce preventable complications, decrease hospitalizations related to diabetic foot disease, and improve patients' overall quality of life. From an organizational perspective, implementing the TNS also supports continuous quality improvement and enhances clinical performance. Standardizing neuropathy screening promotes consistency among healthcare providers, reduces variability in clinical practice, and improves documentation within the electronic health record. More consistent screening practices may increase adherence to evidence-based diabetes management guidelines while strengthening quality metrics related to preventive care. In addition, earlier recognition of neuropathy may reduce costly complications, improve patient satisfaction, and contribute to better long-term health outcomes. These improvements align with value-based healthcare models, which emphasize quality, prevention, patient outcomes, and cost-effective care rather than volume-based services (American Diabetes Association Professional Practice Committee, 2025). The project is also consistent with the organization's business model because preventive care and chronic disease management are central components of primary care practice. Early neuropathy screening using the TNS may reduce emergency department visits, avoid unnecessary hospital admissions, and decrease expenditures associated with advanced diabetic complications. Furthermore, improving quality indicators related to diabetes management can strengthen organizational performance under value-based reimbursement models while enhancing patient retention and community trust. The PICOT elements for this project are as follows: P (Population): Adult Hispanic patients diagnosed with type 2 diabetes receiving care in a primary care clinic. I (Intervention): Implementation of the Total Neuropathy Score (TNS) as a standardized screening tool with provider education. C (Comparison): Current routine diabetic assessment without the standardized use of the TNS. O (Outcome): Improved early identification of diabetic peripheral neuropathy, increased provider knowledge and screening consistency, and earlier clinical intervention. T (Time): Eight weeks. Based on these elements, the PICOT question is: In adult Hispanic patients with type 2 diabetes receiving care in a primary care clinic (P), how does implementing the Total Neuropathy Score (TNS) as a standardized neuropathy screening tool with provider education (I), compared with routine diabetic assessment without standardized TNS screening (C), affect the early identification of diabetic peripheral neuropathy and consistency of screening practices (O) over an eight-week period (T)? As a future DNP-prepared nurse leader, I believe implementing the TNS represents an opportunity to translate current evidence into everyday clinical practice. The project addresses an important gap in diabetic care while supporting evidence-based practice, quality improvement, patient safety, and organizational excellence. By integrating a standardized neuropathy assessment into routine primary care, the organization can strengthen preventive services, improve patient outcomes, and reinforce its commitment to delivering high-quality, patient-centered healthcare. References American Diabetes Association Professional Practice Committee. (2025). Standards of care in diabetes—2025. Diabetes Care, 48(Suppl. 1). https://doi.org/10.2337/dc25-SINT International Diabetes Federation. (2025). IDF Diabetes Atlas (11th ed.). Pop-Busui, R., Feldman, E. L., Callaghan, B. C., et al. (2024). Diabetic neuropathy: Advances in screening, diagnosis, and management. The Lancet Diabetes & Endocrinology, 12(4), 255–268. Schaper, N. C., van Netten, J. J., Bus, S. A., & colleagues. (2024). Practical guidelines on the prevention and management of diabetes-related foot disease. Diabetes/Metabolism Research and Reviews, 40(Suppl. 1), e3805. Tesfaye, S., Sloan, G., Selvarajah, D., & colleagues. (2024). Contemporary approaches to diabetic peripheral neuropathy: Diagnosis, prevention, and treatment. Nature Reviews Endocrinology, 20(5), 289–305.
