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Soon after the diabetes clinical nurse specialist at the University of Washington Medical Center (UWMC) in Seattle transitioned to another role within the organization, diabetes education began to deteriorate without a key individual for clinical teams to consult. To remedy the situation, a team of inpatient and outpatient nurses, clinical nurse specialists, and key personnel for the diabetes care center got together to create a standardized diabetes education initiative.
"Diabetes, like many other chronic illnesses, is a secondary health concern of a large majority of our patients. We tend to see very complex cases for a variety of health concerns," says Cezanne Garcia, MPH, CHES, manager of patient and family education services.
For example, the patient may be admitted for a heart transplant, yet have problems managing his or her diabetes. In that case, the education plan would be put into place and the diabetes education record activated. Often, a patient’s diabetes can become exacerbated with treatment plans for other types of health issues, says Garcia. The initiative helps patients keep their diabetes under control during medical situations that are highly stressful. Their hospital stay also presents a teaching opportunity or teachable moment for diabetes education.
The team of clinicians creating the Diabetes Education Toolbox identified the typical issues that come up during a hospital stay and came up with six key topics that should be covered. They include general facts about diabetes, hyper- and hypoglycemia, blood glucose testing, insulin, oral medications, and discharge information. These topics are on the diabetes education record used to track teaching.
Also on the record are learning cues. For example, the learning objectives for hyper- and hypoglycemia are to describe the causes, symptoms, and treatment. The learning objectives for blood glucose testing are for the patient to state when he or she should test his or her blood glucose and what target range it should be in.
"The education record not only cues the clinicians on the learning objectives and the content to be covered, it also profiles the tools the clinicians are to use to support or reinforce their teaching," says Garcia. The tools include written materials such as Managing Your Diabetes, produced by a pharmaceutical company; a Sharps Safety Flyer that covers disposing of needles properly that was produced by the UWMC Diabetes Care Center; and a brochure listing diabetes patient education classes at the Center.
A series of videos also are shown to the patients that include Basic Skills for Controlling Diabetes, Monitoring Your Blood Sugar, and Injecting Insulin. Videos on particular meters for blood glucose testing are kept on units for use in training patients who purchase meters. The videos can be shown via the closed-circuit television channel but are also kept on each unit in case the patient is ready to see a video before or after it airs on the closed-circuit system. Grant money was used to purchase videos for each unit, says Garcia.
Clinicians use the booklets and videos to prompt the teaching. For example, if they are to teach about blood glucose testing, they turn the second chapter in the booklet, Managing Your Diabetes.
The task force of 12 clinicians that created the Diabetes Education Toolbox met for four months, and each member previewed the videos and booklets at his or her convenience and scored them during the selection process. The preview process ensured that the tools met the needs of their colleagues on the units or in the clinics where they worked. They also went to nurse manager meetings to solicit support for the kits. "We try to engage as many informal and formal key leaders in the clinical care settings in the planning of initiatives because they will have ownership when we roll it out," says Garcia.
When it came time for implementation of the toolbox, a poster was created that profiled its components. The lead coordinator for planning the initiative distributed posters to every floor and offered inservices as needed, which give a quick overview of the tools.
Implementation of the Diabetes Education Toolbox was made very simple. Managers can order its components by number, which include the set of educational brochures, the education record, and a take-home supply box for discharge that contains insulin, syringes, lancets, and a patient logbook. "In my department, we have a student who puts the sets of booklets together rather than having the manager order each booklet from its producer," says Garcia.
To ensure that new staff are aware of the Diabetes Education Toolbox, it is briefly reviewed in the patient education portion of orientation. It’s also included on a list of resources that are available to help clinicians with their teaching.
While there will be deviations from the standard education from time to time for a unique case, Garcia predicts that the toolbox will address 80%-90% of the institution’s diabetes education needs. "The beauty of the work the task force did is that they focused on the key learning objectives, the content and the teaching tools that are needed for six key topics of diabetes education. It is really based upon those standard issues that come up," explains Garcia.
For more information on the Diabetes Education Toolbox and its implementation, contact: