A New Resource for Hospitalized Patients with Newly Diagnosed and Uncontrolled Diabetes

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A New Resource for Hospitalized Patients with
Newly Diagnosed and Uncontrolled Diabetes

• Everet E. Owens, RN, MS., CDE
• Diabetes Educator/Program Coordinator
• Director, Pinnacle Healthcare Diabetes Coalition
• NYS DPCP

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Pinnacle Healthcare Coalition For Diabetes
Prevention and Management

• Pinnacle Healthcare Diabetes Coalition serves
  Westchester, Rockland and Putnam Counties in New
  York State
• Goal of the Coalition is to prevent diabetes,
  increase awareness of diabetes and its risk
  factors and reduce chronic complications among
  high risk populations
• New York State Department of Health funds
  Pinnacle Diabetes Coalition

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Research

• Research studies have shown that Diabetes
  Self-Management Education helps people with
  diabetes to better care for themselves and
  improve their health and quality of life

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ADA Recommendation for Diabetes
Self-Management Education

• The American Diabetes Association recommends that
  people with diabetes receive Self-Management
  Education at the time of their diagnosis and as
  needed thereafter

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Physicians and Nurses Dissatisfaction

• Physicians and nurses within Sound Shore Health
  System were dissatisfied with the quality of
  diabetes self- management education provided to
  hospitalized patients with diabetes
• Endocrinologist (Physician Liaison) discussed
  in-patient needs at Diabetes Advisory Committee
  meetings

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ADA Recognized Out-Patient Diabetes
Program

• Sound Shore Medical Center has an American
  Diabetes Association Recognized Outpatient
  Program
• Finite staff cannot focus on both inpatient and
  outpatient areas

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Nursing Staff Needs Assessment

• Factors related to inadequate patient education
  include
• Overall lack of knowledge in areas pertaining to
  diabetes
• Deficits in how to educate patients in basic
  self- management skills
• Lack of knowledge related to making referrals to
  appropriate community resources

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Administrative Support

• Needs identified Concept of Diabetes Resource
  Nurse (DRN) Program created
• Meeting with Sr. Vice President of Nursing
  Services to discuss problem, (patient and staff
  needs) program development and implementation
  plan
• Sr. Vice President approved plan

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Administrative Support

• Nurse Managers
• - Helped to motivate their nurses, arranged for
  their 2-days off and adequate unit coverage
• Professional Education Dept.
• - Helped to provide continuing education credits
  and other logistics such as facility,
  pre- registration and audio visual needs

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Objective

• To enhance the education and care of hospitalized
  patients with newly diagnosed and uncontrolled
  diabetes through improved providers education

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Goal

• Staff nurses would be able to explain the basic
  pathophysiology of diabetes and instruct patients
  with diabetes in self-management skills i.e.,
  taking medication safely, self blood glucose
  monitoring, basic nutrition, role of exercise,
  prevention and management of hypoglycemia, foot
  care, and follow-up after discharge, with the
  eventual goal of avoiding complications and
  repeat hospitalizations

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Program Curriculum

• Curriculum based on the American Diabetes
  Association (ADA) Clinical Practice
  Recommendations
• ADA Diabetes Self-Management Education 10
  Content Areas
• American Association Diabetes Educators 7 Self-
  Care Behaviors (AADE-7)

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Program Schedule Day 1

• 800 am 845 am Introduction and
  pre-test
• 845 am 945 am Basic pathophysiology of
• 
  diabetes
• 945 am 10 00 am Break
• 1000 am 1100 am Nutrition
  therapy
• 1100 am 1200 pm Role of
  exercise
• 12 00 pm 100 pm Lunch
• 100 pm 245 pm
  Medications (insulin and oral
  
  diabetes medications
• 245 pm 3 00 pm Break
• 300 pm 345pm Self monitoring of blood
• 
  glucose
• 345 pm 400 pm Hemoglobin
  A1C
• 4 00 pm -- 430 pm
  Day 1 post-test and discussion

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Program Schedule Day 2

• 8 00 am - 8 30 am Pre
  -test and discussion
• 830 am 915 pm Acute
  complications (Hypoglycemia, DKA,
• 
  HHNC)
• 915 am 1000 am Chronic
  complications
• 1000 am 1015 am Break
• 1015 am 1045 am Foot care
• 1045 am 1100 am Sick day
  routine
• 1100 am 1115 am Psychological
  aspects of diabetes
• 1115 am 1145 am Setting goals
• 1145 am 100 pm Lunch and learn
  Insulin pumps
• 100 am 130 pm Routine MD
  visits
• 130 pm 200 pm Follow-up after
  discharge
• 200 pm 215 pm Break
• 215 pm 345 pm Review of
  content areas
• 345 pm 430 pm Post- test,
  closing, and evaluations

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Pre-test

•  Name_________________________________________
• 1. All of the following are common
  causes of hypoglycemia in individuals with type 2
  diabetes except
• a. Skipping a meal
• b. Strenuous exercise without a snack
• c. Sulfonylurea (e.g. glyburide, glipizide)
• d. Metformin
•  
• 2. The best of the following choices to treat
  hypoglycemia is
• a. 8 oz skim milk
• b. 4 oz milk regular milk
• c. One glucose tablet
• d. 8 oz orange juice
•  
• 3. Characteristics of DKA include all of the
  following except
• a. Nausea and vomiting
• b. Dehydration
• c. Fluid overload
• d. Altered electrolytes

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Pre-test contd

• 6. A person with diabetes should have a
  dilated eye exam every
• a. 6 months
• b. 12 months
• c. two years
• 7. Symptoms of diabetic neuropathy
  include all of the following except
• a. Tingling or numbness in the feet
• b. Impotence
• c. Prroteinurea
• d. Gastro paresis
•  
• 8. All the following are important aspects of
  foot care except
• a. Never going barefoot
• b. Moisturizing between the toes
• c. Immediate attention to red or infected areas
• d. Daily foot inspection
•  
• 9. Appropriate goals for a patient with
  diabetes should be
• a. Set by the health care provider

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Nurses Pre-test Scores Day 1
and 2

• Pre-test scores ranged from
• 40 to 70
• 50 to 70

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RESULTS
Percentage
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Results

• The Diabetes Resource Nurse Program received
  overall excellent satisfaction rating from
  attendees
• Most DRNs commented that they were better
  equipped to provide diabetes counseling and care
  to patients , and support to their colleagues
• DRNs are providing patient education and making
  appropriate referrals
• Physicians have verbalized increased satisfaction
  for diabetes patient education

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Patient Educational Materials

• Patient educational materials in English and
  Spanish provided and stored in easily accessible
  areas on each unit
• Diabetes Resource Nurses can replenish their
  supplies from a central location as needed

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DRN Follow-up

• Follow-up/ review sessions held 2x per year
• -Review new advances in diabetes management
• - Forum for DRNs to provide feed back

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Challenges

• Rather than seek the support of Diabetes Resource
  Nurses some nurses tend to rely on DRNs to
  initiate diabetes education for patients assigned
  to their care
• DRNs ( staff) turn over leave gaps on units

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Conclusions

• Thirty four nurses were specially trained to
  provide care to hospitalized patients with
  diabetes.
• These personnel are helping to improve diabetes
  management and have positive impact on the lives
  of people with diabetes as well as the healthcare
  system
• Patients are taught the skills necessary to help
  better manage their diabetes until they are able
  to access comprehensive out-patient diabetes
  education programs
• We will recruit and train more DRNs to fill gaps
  created by staff turnover

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Questions

• For further information on Diabetes Resource
  Nurse Program
• Everet Owens
• 914-365-4059
• eowens_at_sshsw.org