Diabetic Education Inpatient? Outpatient?

Specialties Endocrine

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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:

NancyJo, I'm sure what you do for your patients is greatly appreciated. A homecare nurse that might follow your patients then would have an opportunity to build on the teaching that you have started.

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.

An order for insulin is different from requiring a prescription for a patient. One can walk into any pharmacy and pick up a vial of insulin. Why are you blaming the nurse? It is the failure of their physician to tell them they need to go on insulin, not the nurses. :angryfire However, the nurses have failed in part, because they did not bring it to the attention of the physician.

Grannynurse :balloons:

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.

If you don't mind me asking, where is here? I have lived in two different states, plus traveled and never had to have a script for insulin. For my syringes yes but insulin no. Most states do not require insulin prescriptions, so I am wondering which one you live in, that does?

Grannynurse :balloons:

An order for insulin is different from requiring a prescription for a patient. One can walk into any pharmacy and pick up a vial of insulin. Why are you blaming the nurse? It is the failure of their physician to tell them they need to go on insulin, not the nurses. :angryfire However, the nurses have failed in part, because they did not bring it to the attention of the physician.

Grannynurse :balloons:

I was mainly speaking about a patient who is now insulin dependant being sent home without necessary DM supplies or the proper teaching to manage his condition. I have a problem when a glucometer,syringes and insulin have not been arranged before discharge. Every pharmacist I have ever called regarding insulin needs has always needed an order or prescription. I have never had a pharmacist say it wasn't necessary.

Grannynurse,

I work in Illinois. We have to have the script for the insulin and syringes also.

I was mainly speaking about a patient who is now insulin dependant being sent home without necessary DM supplies or the proper teaching to manage his condition. I have a problem when a glucometer,syringes and insulin have not been arranged before discharge. Every pharmacist I have ever called regarding insulin needs has always needed an order or prescription. I have never had a pharmacist say it wasn't necessary.

Most states do not require a prescription for insulin, although there are a few that still do. My physician furnished my glucometer, for free, to me. And a script for my insulin. My diabetic teaching consisted of having a person come up, hand me a few sheets of paper and asking if I had any questions. Fortunately, I didn't have that many questions and knew where I could get the necessary information. Unfortunately, most new diabetics are not nurses or don't have a nurse friend or family member. I go to some of the diabetic message boards and am amazed at the amount of misinformation that is posted. And the focus on having the lowest blood sugars and not eating enough carbs. It is unreal.

Grannynurse :balloons:

:uhoh21:

Most states do not require a prescription for insulin, although there are a few that still do. My physician furnished my glucometer, for free, to me. And a script for my insulin. My diabetic teaching consisted of having a person come up, hand me a few sheets of paper and asking if I had any questions. Fortunately, I didn't have that many questions and knew where I could get the necessary information. Unfortunately, most new diabetics are not nurses or don't have a nurse friend or family member. I go to some of the diabetic message boards and am amazed at the amount of misinformation that is posted. And the focus on having the lowest blood sugars and not eating enough carbs. It is unreal.

Grannynurse :balloons:

:uhoh21: :uhoh21:

I am not even a nursing student yet and know all too well the pitfalls of diabetic education to new or otherwise established diabetics, Type I and II. As I see it this inadequacy needs to be addressed yesterday. DM will be the new plague in only a matter of a few paltry years. We as nurses cannot assume a pt knows anything and I do not find it surprising that a pt taking insulin not know they are diabetic. How many pts have you had that seem to be ignorant of what we know /consider basic info??? Have you ever seen someone who thinks a double quarter pounder, lg fries and a coke is an ok lunch or dinner?? Remember that if you assume you run the risk of making an @ss- (out of) u and me . Or worse run the risk of not giving needed info to someone whose health will be at serious risk. Or make sure they understand that info. As to an actual diabetic educator, in my area it takes up to 6 months to get an appt. and it is MHO that it is the ability of these educators and not the Dr to truely "control" the sugars of many DM pts. And I know w/o being told bedside nurses don't have the time but the system does need improvement and I think the checklist is an excellent idea- at least each nurse would know what has been covered and understood. I plan to do this in my own head so to speak when I am a practicing nurse (which I hope is soon). Just a thought or two (I have MORE) from the daughter of a Type I and a type II.

Most states do not require a prescription for insulin, although there are a few that still do. My physician furnished my glucometer, for free, to me. And a script for my insulin. My diabetic teaching consisted of having a person come up, hand me a few sheets of paper and asking if I had any questions. Fortunately, I didn't have that many questions and knew where I could get the necessary information. Unfortunately, most new diabetics are not nurses or don't have a nurse friend or family member. I go to some of the diabetic message boards and am amazed at the amount of misinformation that is posted. And the focus on having the lowest blood sugars and not eating enough carbs. It is unreal.

Grannynurse :balloons:

Unfortunately, your experience has been a bad one--as you can see from my previous answers you are not alone. I can say that at the agency I worked for we did indepth teaching using written materials and demonstration along with NCP's. Nursing educated the patient on DM diet,portion size,s/s hyper/hypoglycemia and actions to take,what to do on sick days,foot care/skin care,meds,when to notify MD. Our dietician reviewed each patients diet and physical status including lab results and made appropriate recommendations for better blood sugar control. Also upon discharge from homecare services the patient would be directed to classes offered by local hospitals that usually were free.

HI THERE.

CONTACT AN OMBUDSMEN IN YOUR AREA!

YOU MIGHT WANT TO BECOME A REPUBLICAN AND JOIN NFRW GO AND VISIT http://HTTP://WWW.NFRW.ORG AND OPEN A CLUB IF YOU DO NOT HAVE ONE IN YOUR AREA AND THEN GET INVOLVE WITH YOUR LOCAL ASSEMBLY MAN AND ALSO GET INVOLVE WITH LEGISLATIONS!

CONTACT ALSO YOUR LOCAL STATE SENATORS!

AND THEN HAVE THEM WORK ON MEDICARE PAYING ONCE AGAIN DIABETIC EDUCATION!

ALSO YOU MIGHT WANT TO GET SOME BROCHURES FROM YOUR PHYSICIAN OR HOSPITAL ABOUT DIABETIC!

BUT GET INVOLVE ALSO WITH YOUR ETHNIC BACKGROUND AND MAKE THEM STRONG IN YOUR CITIES SO OPEN AN ASSOCIATION OF YOUR ETHNIC BACKGROUND!

MABUHAY!

KATHY

KPOP

No thanks. I am a Democrat and very involved with my political part. And am aware of the process of getting legislation written and past. Unforunately, my Republication Congressperson is only intersted in saving money and reducing benefits. And since all of the hospitals, in my county, are for-profit facilities, nothing is ever free for them. :angryfire

Grannynurse :balloons:

Unfortunately, your experience has been a bad one--as you can see from my previous answers you are not alone. I can say that at the agency I worked for we did indepth teaching using written materials and demonstration along with NCP's. Nursing educated the patient on DM diet,portion size,s/s hyper/hypoglycemia and actions to take,what to do on sick days,foot care/skin care,meds,when to notify MD. Our dietician reviewed each patients diet and physical status including lab results and made appropriate recommendations for better blood sugar control. Also upon discharge from homecare services the patient would be directed to classes offered by local hospitals that usually were free.

As you can see, I live in a county with three for-profit hospitals. None of their classes are free. I travel up the interstate, to the next county, to attend classes offered in their public hospital. When I am in the hospital, and it has been more frquently the past nine months, if I don't get a written order from my doctor or the ER physician, I can't regulate my own diet. I received very good information from the diabetic nurse educator, at Albany Medical Center, when I was first put on insulin. I hadn't really stuck to a diet plan prior to that. Your facility sounds like it is living up to the committment to their diabetics. I wish I could refer patients to you, once I get my MSN. :p

Grannynurse :balloons:

;)

As you can see, I live in a county with three for-profit hospitals. None of their classes are free. I travel up the interstate, to the next county, to attend classes offered in their public hospital. When I am in the hospital, and it has been more frquently the past nine months, if I don't get a written order from my doctor or the ER physician, I can't regulate my own diet. I received very good information from the diabetic nurse educator, at Albany Medical Center, when I was first put on insulin. I hadn't really stuck to a diet plan prior to that. Your facility sounds like it is living up to the committment to their diabetics. I wish I could refer patients to you, once I get my MSN. :p

Grannynurse :balloons:

It sounds like you've been having a difficult time,I wish I had some answers for you. I did find this website that you might find helpful.

http://www.worldwidediabetes.com

Good Luck!!!!!

Specializes in Medical.

I'm an endocrinology CNS and work on a mixed specialty (including endocrinology) ward, and so am very familiar with how difficult teaching can be, both with newly-diagnosed and established diabetes.

We are fortunate enough to have two diabetes education nurses, who service the hospital - they get blanket referrals with all newly-diagnosed cases, and can be referred by any member of the team for patients previously diagnosed with diabetes who present with another problem but where there is concern about diabetes management.

The educators set up a program of slowly escalating patient responsibility, with blood glucose monitoring, recording, and administration of meds and/or insulin. The nursing staff caring for the patient document this in the patient's record - if the patient needed prompting, or initiated monitoring; how well they managed; if they drew up the appropriate dose etc.

Patients who are admitted with a diabetes-related problem (eg DKA, worsening renal function) or who have unstable/high/low BSLs while admitted have an HbA1C performed, referral to diabetes education, and to the endocrinology team if the unit are having trouble with management. They also have an endocrine outpatients appointment made as part of discharge follow-up.

We have pamphlets in a number of languages about what to do in the case of illness, and recommended websites (like Diabetes Australia). We also have a tick list of what to do for optimal management - monthly podiatry appointments, quarterly check ups by the LMO, six-monthly endocrinology reviews, and yearly ophthalmology assessment, plus nephrology review if there are early indications of renal failure.

Unfortunately not every one is able or prepared to follow these guidelines. My favourite is when a patient with two half legs, chronic renal failure, ishemic heart disease and retinopathy tells me that they know their sugars and it's fine if they're that high. And even the most compliant patient can run into trouble, especially if their LMO thinks s/he can manage diabetes on their own. Don't get me wrong, many times they're fine, but the number of patients I've had come in with near-end-stage renal failure, who'd never been seen by an endocrinologist or nephrologist...!

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