Training 15 nurses to serve as “diabetes champions,” a pilot program at a Canadian hospital identified and managed every patient with diabetes admitted as an inpatient.
The diabetes champions at the University of Ottawa Heart Institute provided peer-to-peer training to other nurses, physicians, dietitians and medical and surgical residents, centered on a new guideline and educational “tool box” designed to walk staff through the steps to identifying and managing diabetes with every patient.
In February, the optional guideline became a mandatory medical directive and by March, the number of patients referred to the diabetes nurse specialist had doubled. After implementation of the program, physicians were notified of patients diabetic status in 85% of cases, compared with 26% before the program. And 34% received a referral to a community diabetes management program, compared with none beforehand.
Average blood sugar levels in diabetic inpatients dropped by almost 2% to the target level considered reflective of adequately managed diabetes. According to a hospital news release, the “development of a systematic plan to educate staff on the management of diabetes, identifying on admission those affected by diabetes, diagnosing diabetes and standardizing the treatment of diabetes within our institution and ensuring timely, seamless transition to the community for self-management care of diabetes with our community partners resulted in a dramatic improvement of HbA1c.”
The United Kingdom Prospective Diabetes Study, a large randomized study trial of intensively managed people living with Type 2 diabetes compared to usual care, showed significant benefits of A1c reduction: For each 1% drop, there was a 43% lower risk of amputation or death from peripheral vascular disease, 37% lower risk of blindness and kidney failure, 21% lower risk of diabetes complications, 21% lower risk of death related to diabetes, 14% lower risk of myocardial infarction and 12% lower risk of stroke.
Challenges still being addressed include how to fit all the pieces of the program into patient care for brief stays, such as overnight or elective day surgery, and how to influence patients who refuse to accept an unexpected diagnosis.
“There was also the challenge of ‘This is just one more piece of paper in an already busy day, or one more thing to do,” said Bonnie Quinlan, BScN, MScN, an advanced practice nurse at the Heart Institute. “This barrier seemed to become less of an issue as the program gained momentum. Staff felt empowered by being able to manage their patients diabetes and felt tremendous positive feedback from patients and families who in many cases for the first time were receiving support to assist them in managing this chronic disease.”
The pilot program will be the subject of a presentation scheduled for Oct. 29 at the Canadian Cardiovascular Congress in Toronto.