Meeting Minutes: Shadyside Diabetes Care Team

Transcription

1 Meeting Minutes: Shadyside Diabetes Care Team Date: Thursday, December 15, 2011 Time/Location: 1:00 2:00 pm Large Board Room Recorded by: Kellie Antinori-Lent, MSN, RN, CDE, Chair Guests: Rose Gallo from Lilly, Leslie Kiley from BD, Mary Ellen Young from CCS Medical Attendees: Maria Cukrzynski 2S/2PAV Krystle Mientkiewicz 3 Main Jamie Detman 3 East Gina Weiser 4 Main Jan Mikan 4/5 PAV & South Kristopher Hayes 5 Main Meg McWhirter 5 West May Miller 5 East/SSU Kassandra Cooney 6 Main Pam Turzak 6 West Mary Catherine Clarke 6/7 PAV Lisa Schlarman 7 West Maggie Judge ASC Diane Klein DAS Jennette Bonifate DAS Patty Kammerer erecord Stephanie Deible ED Janita Daniocek Float Pool/Admission Team Terry Manko CP Rehab Brigid Neary Nutrition Bethanne McCabe Nursing Education Linda Lakdawala Nursing Education Lynn Bates Pharmacy Pam King CTICU Courtney Snyder NSICU Gail Piole Radiology Debbie Panos SICU Sue Dunn Shea Medical Minutes Annual Plan The 2012 Annual Plan was presented, including a review of the 2011 Diabetes Care Team accomplishments. The Diabetes Care Team (DCT) purpose, goals, and member responsibilities were reviewed. The revised Diabetes Education Model, Diabetes Education Checklist, and new Care of the Patient with Diabetes nursing policy will all be discussed during the January DCT meeting.

2 A copy of the Annual Plan presentation will be ed to all DCT members, Unit Directors, and Advanced Practice Nurses. DCT Representatives are asked to share information learned at the meetings with staff via weekly updates, staff meetings, , and flyers. The Diabetes Back to Basics Blitz The Diabetes Back to Basics Blitz (BBB) is an educational program aimed at educating staff nurses about the basics of diabetes education, care of the patient with diabetes or stress induced hyperglycemia, and hospital policies/procedure changes. The BBB was first trialed on 3 East staring in November. It includes 15 minute in-servicing on specific diabetes related topics. The program runs Monday, Wednesday, and Thursday of week 1 and the following Thursday of week 2. If 75% of staff is in-serviced, the program concludes. If not, follow-up in-servicing is planned according to the work schedules of those not yet trained. The topics taught during 1 st phase of blitzing include: the new IV insulin infusion protocol (including how to give a bolus of insulin using the Alaris pump), the updated hypoglycemia protocol, home glucose meter training (how to teach patients to use the take home meters), and carb counting using the Shadyside menu. Both 5 Main and 6 Main will begin the program in January; 4 East and 3 Main will begin in February. Others will be phased in throughout the year. DCT Representatives of those units involved in phase 1 of the program which begins in January and February are asked to share this information with their UD s. Kellie will insure both UD s and DCT Representatives are informed of program plans. Current Diabetes Education Model at Shadyside The current diabetes education model was shared with the group. It should be communicated to all staff that electronic consults for diabetes education is a consult for the staff nurse to know they are to begin diabetes education. The consult is no longer to be seen as a consult for the Diabetes Advanced Practice Nurse (DAPN) to see the patient. The DAPN must be paged/called to schedule education. If she is not available, the staff nurse is responsible for teaching Survival Skills prior to the patient being discharged. Survival Skills are those self-behavior tasks that will insure the patient is safe for discharge. They include the 3 M s and 1 H: Medications (including insulin administration) Monitoring (obtain a meter and teach how to use) Meal Planning (the nurse is responsible for insuring there is an RD consult and that it is completed) Hypoglycemia If the patient needs additional diabetes education (and most will), the patient should be referred to the out-patient diabetes education program at Shea Medical. A copy of the referral form was Page 2

3 handed out. The form can also be found in Print On Demand, Shadyside location filter, in the nursing folder under diabetes. The complete revised plan for diabetes education, as noted above, will be unveiled during the January DCT meeting. It is vital that DCT Representatives share this information with staff ASAP. Diabetes STATS The glycemic control and needle stick injury rates for the month of October were shared with the group. Findings: Glucoses in goal ( mg/dl) 73% (goal > 75%) Not Met Critical Hypoglycemia (< 50 mg/dl) 0.4% (goal < 1%) Not Met Hyperglycemia (> 300 mg/dl) 4% (goal < 5%) Met Critical Hyperglycemia (> 500 mg/dl) 0.3% (goal < 0.1%) Not Met The Diabetes Advisory Committee has recommended changing the benchmark for critical hypoglycemia on the basis that the goal set by Shadyside is much stricter than national benchmarks. This will be changed with the compilation of the November 2011 data. The new value will be changed based on national standards. The critical hyperglycemia rates may also change based on the same criteria. The insulin related needle stick injuries were noted. There have only been 2 needles sticks associated with the pens in 2011; 17 with insulin syringes (corrected from that noted at meeting; added in January March numbers). The goal is 0 injuries associated with insulin. A copy of the Diabetes STATS presentation will be ed to all DCT Representatives, Unit Directors and Advanced Practice Nurses. New Pen Portfolio Lynn Bates, Shadyside Lead Pharmacist, Informatics Specialist, shared the good news that, after 2 years, it is planned that Shadyside will advance to an full insulin pen portfolio! The tentative date of this transition is Wednesday, February 1, The portfolio will include only insulin analogs. The pens that will be added include: Humalog (lispro) Kwik Pen Novolog (aspart) Flex Pen Apidra (glulisine) SoloStar Pen Humalog Mix 75/25 Kwik Pen Novolog Mix 70/30 Flex Pen Humalog Mix 50/50 Kwik Pen Page 3

4 Lantus and Levemir will continue to be available. Lynn noted the Apidra Solostar Pen is on a worldwide back order. Regular and Novolin 70/30 is not available in pen form. NPH and Humulin 70/30 are available in pen form, but will not be on formulary at Shadyside. Hospital-wide training on the Lilly pens will be completed in January. This will be completed by Diabetes Educators from Lilly. Key educational points: NEVER, NEVER, NEVER share insulin pens between patients!!! Insulin pen mixtures (Humalog Mix 75/25 and Novolog Mix 70/30) must be re-suspended prior to use A 2 unit air shot must be completed prior to each injection Insure that the dial returns to 0 after air shot and injection A copy of the new insulin pen portfolio was handed out at the meeting. A copy of the sheet will be ed to all DCT members, Unit Directors, and Advanced Practice Nurses. Diabetes Quick Reference Binder Jamie Detman, DCT Representative from 3 East shared the Diabetes Quick Reference Binder she made for her unit. The binder included key diabetes education communications, reference materials, policies, protocols, and order sets. She is using it as a part of her Level 3 project. She passed the binder around to share with other DCT Representatives. She shared her for anyone to contact her with any questions. Color copes of the Diabetes Facts of the Week can be obtained from Kellie Antinori-Lent. Lilly Insulin Pens at Discharge Training Rose Gallo, Sales Representative from Lilly and Company, shared the insulin teaching materials available for teaching patients how to use the pens. Lilly has offered to in-service nurses throughout the hospital on the pens and the Lilly pen teaching kits. The DCT Representatives liked the materials and agreed that this would benefit the nursing staff. Kellie Antinori-Lent will work with Rose to set up a training schedule for January. NEW BD Safety Pen Needles -- Leslie Kiley, Sales Representative from BD, demonstrated the new BD Autoshield Duo pen needle. What is different? The Autoshield Duo has a safety device on the back to prevent needle stick injuries after injection. Kellie reported that of the 2 needle stick injuries this year, 1 was from this back end needle. The only concern is with leaking at the injection site with large doses of insulin. This concern stems from the length of the pen needle which is 5mm (3/16 ). Our current pen needle is 8mm (5/16 ) and we see some leaking at the site with it, even with proper technique. It was noted that the insulin syringes currently used at Shadyside have 12.7mm (1/2 ) needles. DCT Representatives had the opportunity to try the new Page 4

5 needles. All liked them better than the current pen needle, the Novofine Autocover, noting it was easier to use and liked the back end safety piece. In order to insure there will be no problem with leaking with large doses of insulin, Kellie Antinori- Lent asked if we could trial the needles on 3 units for 2 months. Leslie said that BD would accommodate our request. Kellie will first have to submit to the VAT committee for approval. The units that volunteered, pending Unit Director approval, to be one of the test sites include 5 Main, 6 Main, and 3 East. Meters for Patients -- Maryellen Young, RN, CDE from CCS Medical, the company that provides us with our Home Glucose Meter Kits, discussed the meter program. An open discussion took place regarding which meter to continue to have available in Central. Options included continuing to have both the One Touch Ultra 2 and Bayer Contour USB available, only having one meter available, or having one meter available for the oncology units and another for all others. The One Touch Ultra has a HCT range of 30 55%, the Bayer Contour 0 70%. Time ran out and was not able to come to a decision. The discussion was tabled till the next meeting. Of importance was the notation that the company PUH/MUH was obtaining their meters from has discontinued the program. In order to prevent this from happening at Shadyside, there was a request to insure all staff is aware of the need to complete the Program Activation Kit Referral Form. It can be found in the front pocket of the blue/orange bag the meters come in. This form must be faxed to the number found on the top right corner of the form. This insures CCS will be aware of who has been given a meter kit and permit them to follow-up with them. If a patient is given a meter that is not covered by their insurance company, CCS will provide them with one that is. DCT Representatives are asked to insure nurses are aware of the importance of completing the top portion of the Program Activation Kit Referral Forms and faxing them to the number on the form. After the Holidays Dinner Program Sanofi Aventis program at Monterey Bay, February 1, 2012 at 6:00 pm. Dr. Sachin Bahl will discuss A Stepwise Approach to Initiating and Titrating Insulin. You must RSVP to attend this program. Details will be mailed to DCT members. Page 5

6 Action Items (RTU = Report to Unit) Action Assignee Deadline Diabetes Education Model Changes--RTU All DCT Representatives January 2012 Staff Nurse Diabetes Education Responsibilities (Survival Skills)--RTU All DCT Representatives January 2012 Diabetes Back to Basics Blitz Schedule--RTU DCT Representatives from 3 East, 5 Main, 6 Main, 4 East, 3 Main January 2012 New Insulin Pens coming to Shadyside--RTU All DCT Representatives January 2012 Lilly Insulin Pen In-servicing Schedule Kellie Antinori-Lent January 2012 New BD Insulin Pen Needle Pilot on 3 units Kellie Antinori-Lent January 2012 Meters for Patients completion of Program Activation Form--RTU All DCT Representatives January 2012 Next Meeting: Large Board Room, Thursday, January 19, 2012, 1:00 2:00 pm Page 6