Diabetic Education Inpatient? Outpatient?

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I am an insulin dependent Type 2 diabetic. It has been some years since I did any diabetic teaching and am now preplexed at some of the information that I have received, both as an inpatient and as an outpatient. I am wondering just what inpatient, as well as out patient, nurses think is their responsibility in educating a new diabetic or adding to the education of a diabetic who has been one of a number of years. Do you feel that a hospitalized patient should be taught to know when and how to take his medications? To have consistent eating patterns? To have knowledge of symptoms and foods for hypoglycemia? To understand who and when to call for help? Do you believe that hospitalized patients are too ill to learn or retain information or skills? Do you believe that there are abundant resources for outpatient education? Are there diabetic educators available at your facility? Do you believe, as a staff nurse, that you have adequate knowledge to educate patients? Does your facility provide education sources for you the staff nurse, to update your knowledge? Do you believe that education is a lenghty, complex, and elective process? Do you bvelieve that the education, in the hospital, is essential? Do you believe that outpatient programs are not equiped to address such complex issues? Do you feel management supports your efforts and gives you the time? Are you aware that Medicare pays little for 're-education'? Are you aware of the programs available, in your community, at little or no cost? Does your facility offer such programs and do they charge for them?

Thank you for any who decide to answer my questions.

Grannynurse :balloons:

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I am an insulin dependent Type 2 diabetic. It has been some years since I did any diabetic teaching and am now preplexed at some of the information that I have received, both as an inpatient and as an outpatient. I am wondering just what inpatient, as well as out patient, nurses think is their responsibility in educating a new diabetic or adding to the education of a diabetic who has been one of a number of years. Do you feel that a hospitalized patient should be taught to know when and how to take his medications? To have consistent eating patterns? To have knowledge of symptoms and foods for hypoglycemia? To understand who and when to call for help? Do you believe that hospitalized patients are too ill to learn or retain information or skills? Do you believe that there are abundant resources for outpatient education? Are there diabetic educators available at your facility? Do you believe, as a staff nurse, that you have adequate knowledge to educate patients? Does your facility provide education sources for you the staff nurse, to update your knowledge? Do you believe that education is a lenghty, complex, and elective process? Do you bvelieve that the education, in the hospital, is essential? Do you believe that outpatient programs are not equiped to address such complex issues? Do you feel management supports your efforts and gives you the time? Are you aware that Medicare pays little for 're-education'? Are you aware of the programs available, in your community, at little or no cost? Does your facility offer such programs and do they charge for them?

Thank you for any who decide to answer my questions.

Grannynurse :balloons:

Wow thats alot of questions there. I'm a student nurse working on a diabetes and endo ward at the moment (i've been there 2 weeks) I'll tell you how it works on there.

Yes I think it is the nurses responsibilty to educate the inpatient. Here there is a checklist for all newly diagnosed patients on insulin or those converting to insulin from tablets. before discharge they must have completed the checklist and been assed where necesarry.

administering all own insulin-knowing times, doses,

be able to test blood sugar on their meter

been talked through foot and eye care and have handout information.

seen by the dietitian

before they leave they will be given emergency numbers of who to contact. they will also be given the name of their diabetes specialist nurse that covers their area. they will be given an outpatient appointment.

All the pateints are medically well enough to be educated and to take in information.

Personally I don't feel competent in educating diabetic pateints, I've only been there 2 weeks, but there are things that I am confident in doing, like teaching blood glucose monitoring and assessing the pateints doing it.

i think that education is complex and an ongoing process which will continue through outpatients appointments. We teach very little about altering insulin dosages according to meals because It's felt that it's too much information to take in and the pateints needs more experince to be able to accuratly do that.

I don't think that all type 2's converting to insulin necesarrily need to be hospitalized.

The questions about cost don't really apply as NHS funds the care.

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Wow thats alot of questions there. I'm a student nurse working on a diabetes and endo ward at the moment (i've been there 2 weeks) I'll tell you how it works on there.

Yes I think it is the nurses responsibilty to educate the inpatient. Here there is a checklist for all newly diagnosed patients on insulin or those converting to insulin from tablets. before discharge they must have completed the checklist and been assed where necesarry.

administering all own insulin-knowing times, doses,

be able to test blood sugar on their meter

been talked through foot and eye care and have handout information.

seen by the dietitian

before they leave they will be given emergency numbers of who to contact. they will also be given the name of their diabetes specialist nurse that covers their area. they will be given an outpatient appointment.

All the pateints are medically well enough to be educated and to take in information.

Personally I don't feel competent in educating diabetic pateints, I've only been there 2 weeks, but there are things that I am confident in doing, like teaching blood glucose monitoring and assessing the pateints doing it.

i think that education is complex and an ongoing process which will continue through outpatients appointments. We teach very little about altering insulin dosages according to meals because It's felt that it's too much information to take in and the pateints needs more experince to be able to accuratly do that.

I don't think that all type 2's converting to insulin necesarrily need to be hospitalized.

The questions about cost don't really apply as NHS funds the care.

Thank you for your reply. I have some questions, the main one being the question of cost. NHS funds, are you located in Great Britain? Here in the United States, education is generally not covered by health insurance and post hospital education is definitely not covered by Medicare and Medicaid.

As for your comment on altering insulin coverage. I am placed on a sliding scale only when I take prednisone, which greatly effects my blood glucose levels. Here, generally it has not been my experience to cover rises in blood sugars otherwise. I have to alter my diet and/or increase my excerise level.

Again, thank you for your reply.

Grannynurse :balloons: :coollook:

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Specializes in Med-Surg.
Thank you for your reply. I have some questions, the main one being the question of cost. NHS funds, are you located in Great Britain? Here in the United States, education is generally not covered by health insurance and post hospital education is definitely not covered by Medicare and Medicaid.

As for your comment on altering insulin coverage. I am placed on a sliding scale only when I take prednisone, which greatly effects my blood glucose levels. Here, generally it has not been my experience to cover rises in blood sugars otherwise. I have to alter my diet and/or increase my excerise level.

Again, thank you for your reply.

Grannynurse :balloons: :coollook:

In the inpatient setting, we as nurses give patients "survival skills for diabetics". Most insurance will not cover a home nurse to even for one day to visit the patient to make sure they are ok. If the patient can get into a car and get out of the house, they can go to our outpatient diabetic nurse educator. I don't think our teaching is adequate, but given the time constraints we are up against, it's all we can do and hope for the best. I have to tell you that it's not a good system at all especially for new diabetics that are going to be on insulin and maybe live with family who don't want to deal with it ( I had a patient like that and on a very complicated insulin regimen). I did the very best I could for the two days I had her, but really didn't feel that great about her going home. I just hoped she followed up with the outpatient diabetic nurse. Being a PRN nurse, I don't always know what happens to patients if I don't go to the unit for a while. I wish we had a better follow up system. :rolleyes:

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There are definite time constraints, due to short lengths of stay, to teaching inpatients about diabetes not to mention they are sometimes not ready to learn. Most patients need "survival skills" prior to discharge. They need to know about their meds and depending on those meds they may need education about the signs, symptoms, treatment. and prevention of hypoglycemia. They may also need to learn the basics of self blood glucose monitoring. We usually have the outpatient diabetes eduator and dietician make a visit to help assess the patients needs and begin planning their educational plan of care.

It is not true however that their is not usually payment for out patient education. Medicare pays for up to 10 hours the first year and then 1-2 hours each year there after and may pay for more if the patients medical plan of care changes or if they develop complication. Many private insurance companies cover outpatient education also, but it usually requires a physican referral.

Out patient education is the very best setting for diabetes eduaton in my opinion because you can eliminate most distractions and provide "real life teaching".

Debra Moyer RN MSN CDE BC-ADM

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Specializes in Med-Surg.
There are definite time constraints, due to short lengths of stay, to teaching inpatients about diabetes not to mention they are sometimes not ready to learn. Most patients need "survival skills" prior to discharge. They need to know about their meds and depending on those meds they may need education about the signs, symptoms, treatment. and prevention of hypoglycemia. They may also need to learn the basics of self blood glucose monitoring. We usually have the outpatient diabetes eduator and dietician make a visit to help assess the patients needs and begin planning their educational plan of care.

It is not true however that their is not usually payment for out patient education. Medicare pays for up to 10 hours the first year and then 1-2 hours each year there after and may pay for more if the patients medical plan of care changes or if they develop complication. Many private insurance companies cover outpatient education also, but it usually requires a physican referral.

Out patient education is the very best setting for diabetes eduaton in my opinion because you can eliminate most distractions and provide "real life teaching".

Debra Moyer RN MSN CDE BC-ADM

I was talking about payment for a visiting nurse not outpatient teaching. I know that insurance will pay for that if you have a referral from your doctor. In my hospital, the diabetic educators will not come and see the patients before they are discharged ( I wish they would). They told me that they have to be discharged and seen in their office. :angryfire

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In the inpatient setting, we as nurses give patients "survival skills for diabetics". Most insurance will not cover a home nurse to even for one day to visit the patient to make sure they are ok. If the patient can get into a car and get out of the house, they can go to our outpatient diabetic nurse educator. I don't think our teaching is adequate, but given the time constraints we are up against, it's all we can do and hope for the best. I have to tell you that it's not a good system at all especially for new diabetics that are going to be on insulin and maybe live with family who don't want to deal with it ( I had a patient like that and on a very complicated insulin regimen). I did the very best I could for the two days I had her, but really didn't feel that great about her going home. I just hoped she followed up with the outpatient diabetic nurse. Being a PRN nurse, I don't always know what happens to patients if I don't go to the unit for a while. I wish we had a better follow up system. :rolleyes:

Congradualtions on your efforts. Unfortunately many diabetics do not initially follow up on their education. And some go to the internet where they get conflicting messages from people who really do not know what they are talking about. But are proud that the blood sugars are in the low 80s after every meal. Being a diabetic is hard, learning to deal with it is hard. Learning to accept it is even harder. Get the proper information is difficult and a lot of people nurses include, don't get it.

Grannynurse :angryfire

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I was talking about payment for a visiting nurse not outpatient teaching. I know that insurance will pay for that if you have a referral from your doctor. In my hospital, the diabetic educators will not come and see the patients before they are discharged ( I wish they would). They told me that they have to be discharged and seen in their office. :angryfire

I have read your reply and the reply from the MSN. And I find them both interesting. I am on Medicare and have been told that it will not pay for outpatient reeducation, yearly. I see my endo every few months and touch base with his diabetic educator, otherwise, it is off to the university library, to do research on the current trends and recommendations. If I have a question, I call his office and leave a message. Not the most efficent and satisfactory method but it is what I am stuck with. I do not understand why Medicare will not pay for the visiting nurse, unless it is the only reason she/he is visiting. The case has to be made for the nursing necessity of having the visits. And Medicare is paying in block payments. Isn't it up to the agency to decide what is most important and how many visits are to be made?

Grannynurse :balloons:

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In order to be eligible for homecare--you must be homebound,if you can head off to the library,shopping etc. then you probably don't meet Medicare requirements. If you were homebound then your MD could make a homehealth referral and at the very least--you would have an evaluation by a home health nurse who would determine if you needed and met requirements for futher visits.

Also, in answer to your original questions,I do think it is essential that DM teaching begin in the hospital--I can't tell you how many patients I have seen when doing homecare that were sent home without any DM supplies ,insulin was never called into the pharmacy and a few who knew they were getting insulin injections but didn't realize they were diabetic! Let me tell you how difficult it is to arrange for all their needs on a saturday afternoon--not easy! :o

http://allnurses.healthology.com/focus Select Diabetes

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In order to be eligible for homecare--you must be homebound,if you can head off to the library,shopping etc. then you probably don't meet Medicare requirements. If you were homebound then your MD could make a homehealth referral and at the very least--you would have an evaluation by a home health nurse who would determine if you needed and met requirements for futher visits.

Also, in answer to your original questions,I do think it is essential that DM teaching begin in the hospital--I can't tell you how many patients I have seen when doing homecare that were sent home without any DM supplies ,insulin was never called into the pharmacy and a few who knew they were getting insulin injections but didn't realize they were diabetic! Let me tell you how difficult it is to arrange for all their needs on a saturday afternoon--not easy! :o

http://allnurses.healthology.com/focus Select Diabetes

Most states do not require a prescription for insulin. It is important, that upon discharge, a patient be aware of what type of insulin their doctor wants them on and at what dosage. And I believe it is up to the nurse to ensure that the doctor writes an order, so that the nurse can know. A prescription is required for the syringes. I do not uinderstand how a patient could not know he/she was not a diabetic, when receiving insulin. That is the fualt of both the physician and the nurses caring for him/her.

Denise :balloons:

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Most states do not require a prescription for insulin. It is important, that upon discharge, a patient be aware of what type of insulin their doctor wants them on and at what dosage. And I believe it is up to the nurse to ensure that the doctor writes an order, so that the nurse can know. A prescription is required for the syringes. I do not uinderstand how a patient could not know he/she was not a diabetic, when receiving insulin. That is the fualt of both the physician and the nurses caring for him/her.

Denise :balloons:

The patients believed that they only needed the insulin while they were in the hospital because they had never needed it before. I think sometimes the hospital nurses think the homecare nurse can take care of the patients needs........but let's be reasonable! Anyway, I have always needed an order for insulin so I'm not sure what you mean that a prescription isn't required.

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Nursing initiates diabetic teaching for new diabetics while inpatients here. What it usually amounts to here though is having the pt. return demo accuchecks, drawing up insulin and administering the insulin. Often done in a day or two, not really enough time to give adequate training. We do not have a specific education plan for diabetics, I wish we did. I would like to see a flowsheet or a checklist to keep track of what has been covered, since often our assignments may change and sometimes I will get a pt. for the first time on the day of discharge. Most do chart, but face it some are better at documeting then others and sometimes it's difficult to know just how comfortable the pt. is with the info provided. We have an excellent dietician whom I always have come to see my diabetics and she does a short class with them. She also brings a packet catered to their diet plan, sample menu, portion sizes, etc which is written in very simple terms and the diet is simple to follow.

We have educational videos that I offer, but very often pt.'s decline, so usually we talk. We also have access to micromedex which has a section for discharge information for aftercare. It is written in layman terms which I print for pt.'s to read prior to discharge so that I can answer any questions they may have. I also print up the info on their particular insulin or oral hypoglycemics. I work with an RN who is a diabetic educator, and I try to get her in to answer any questions they may have, that of course depends on how busy she is, but she always makes an attempt. I try to do as much as I can before they leave, because it's difficult to get people to do any f/u after discharge. Not sure how many if any insurances cover as outpatient diabetic teaching. I went through diabetic teaching when I was a gestational diabetic years ago and it was all covered, but when a few years later I was diagnosed DM I had my doc send me to the dietician for a refresher course and this insurance(a different one than before) didn't cover it at all and it all came out of my pocket, so I think that is why so many don't follow through.

We also have to have a prescription here for insulin.

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