PEDIATRIC ASSESSMENT PART 2 FOLLOW-UP

Transcription

1 PEDIATRIC ASSESSMENT PART 2 FOLLOW-UP

2 GOALS Consistency Consistent approach to assessing pediatric patients with Type 1 or Type 2diabetes across Nova Scotia One form that can be used for pumpers and non pumpers Information To collect all information required to provide the best possible care to a pediatric patient and their family Gather all information required for DCPNS data base

3 HIGHLIGHTS Name: Date: Non-NSIPP NSIPP Duration of diabetes/age at onset: Current age: Type 1 Type 2 Other Accompanied by: mother father sibs: other: Lives with: mother father other: Information obtained from: mother father child other:

4 Basal (%): Bolus (%): MEAL TIMES COMMENTS Bkfst AM Lunch PM Supper HS (e.g., changes in activity, insulin adjustment, omits, takes when ill, skips meals, etc.) Usual Weekend/Other BASAL RATES: Time Rate TYPE OF INSULIN and/or Non-Insulin Therapy DOSAGE and/or CHO/Ratio ISF: ACTIVE INSULIN TIME: TOTAL UNITS: U/kg: Glucose Targets: Uses Bolus Calculator: N Y Inject/Bolus before meals: N Y How often are insulin/boluses missed? Avg. Bolus per day:

5 INSULIN INSULIN N/A INSTRUCTED (see Education Checklist Prepared by: mother father child other: Injected by: mother father child other: Supervised by: mother father other: Appropriate technique: N Y not observed Sites used: buttock R L leg R L arm R L abdomen R L calf (if applicable) R L Appropriate site rotation: N Y How often is the site changed? Daily Every 2 to 3 days Every 3 to 5 days Every 5 days or more Lipodystrophy: N Y Adjusts insulin: N Y

6 BLOOD GLUCOSE MONITORING N/A INSTRUCTED (see Education Checklist Tested by: mother father child other: Recorded by: mother father child other: Supervised by: mother father other: Appropriate technique: N Y not observed Do you download regularly? N Y Details: Did you download your pump today? N Y Method: Frequency/day/week: Tests 4x/day TIME RESULTS Based on days Based on: Record book Verbal report Computer printout/download AC 2-hr COMMENTS (e.g. weekend variations, range, etc.) Bkfst Lunch Supper hs 12 AM 3 AM Interprets results and acts appropriately: N Y

7 HYPOGLYCEMIA Diabetes ID: N Y SYMPTOMS: headache moody weak shaky hungry sweaty pallor nightmares dizzy other: none Are symptoms recognized by the child? N Y N/A MILD (frequency, times): Treatment Appropriate? N Y What treatment does the child/adolescent carry? MODERATE/SEVERE (Severe hypoglycemia is defined as unable to help self): Y (see below) N Date Treated by: 1) Care giver/family 2) EHS only 3) Emergency Dept. 4) Admission Treated with glucagon ( ) What was the cause of moderate/severe hypoglycemia (note number): 1) Exercise; 2) Insulin error; 3) Missed/late meal; 4) Slept in; 5) Alcohol; 6) Other (please note reason) Glucagon at home: N Y Expiry date checked: N Y Prescription: N Y SCHOOL PLAN IN PLACE: Y N Grade in school: INSTRUCTED (see Education Checklist) Is school prepared to treat? N Y Has teacher been given appropriate information? N Y

8 ACTIVITY ACTIVITY INSTRUCTED (see Education Checklist What types of exercise/activity do you do? None Screen time: Please list: What adjustments are made to insulin/food for exercise(s)? n/a Temporary basal rates Suspend pump Carb coverage Decrease bolus Extra monitoring Insulin Adjustment Snack None

9 SICK DAYS SICK DAYS INSTRUCTED (see Education Checklist Illness since last visit: N Y Number of days sick: Describe blood glucose problems when ill: Diabetes symptoms: polyuria nocturia ( /night) headaches polydipsia enuresis Other: DKA Since Last Visit Y (see below) N Abdominal symptoms: Ketones Checked: N Y When: By whom: Ketones Testing: appropriate inappropriate never Expiry date checked: N Y Action taken: appropriate inappropriate never Date Treated in Hospital Treated in Emergency What was the cause of the DKA (note number)? 1) Insulin omission; 2) Illness; 3) Pump/Pump site failure; 4) Insufficient monitoring; 5) Other (please note reason)

10 SOCIAL ASSESSMENT SOCIAL ASSESSMENT INSTRUCTED (see Education Check Smoking: N Y Amount: Willing to reduce/quit Social drugs: N Y Type/freq: Alcohol: N Y Type/amount/freq: Sexually active: N Y Birth control: STD prevention: N Y Driving: N Y Safe practices: N Y n/a Days missed from school since last visit: School concerns/performance: Family concerns/involvement/changes: Religious, family, or cultural practices that may influence how child/family cares for health:

11 NUTRITIONAL ASSESSMENT NUTRITION--DIETITIAN ONLY (for known patient or new referral if appropriate) CHO counting: N Y Present meal plan (KJ/calories): Meal plan: appropriate inappropriate Compensation for activities: appropriate inappropriate Meal/snack timing: appropriate inappropriate School concerns: N Y Treatment for hypoglycemia: appropriate inappropriate Notable eating patterns: food restrictive behaviour overindulgence Explain: Comments:

12 QUESTIONS AND COMMENTS

13 Insulin Pump Follow-Up Form Update Carrie Haggett RN BScN CDE

14 Objectives: 1. To review the history of the Insulin Pump Follow-Up form. 2. Review how the form was designed. 3. Review the layout of the form. 4. Give your input for the forms improvement.

15 Insulin Pump Follow-up Form Concept designed in Sept 2012 Concept re-visited in June of 2014 we started working with various NSIPP approved sites to develop a form that would allow patient self completion, capture the information needed for NSIPP renewal in the registry and assist educators who aren t as familiar with pump therapy

16 Current Insulin Pump Follow-up form dated Sept 2014 Introduced at the DCPNS Pump Education Day in Nov 2014 Please use for 1 year and than give us your feedback in Nov 2015.

17 Top of Page 1 of the Insulin Pump Follow-up Form INSULIN PUMP FOLLOW-UP FORM (Pages 1, 2 & 3 to be completed by patient/family) To help us make the most of your visit, please take a few minutes to complete this form. Please do not fill in the shaded area on page 3 & page 4. If there are parts you are unsure of, please leave blank and discuss with your team.

18 Page 1 & 2 Are there other things you would like to talk about (please check the most important ones)? Activity Hypoglycemia Self Monitoring of Blood Glucose Goals Sexual Health

19 Page 3 Did you download your pump today? Which Pump and Infusion set do you use? What are your sites like and how often do you change sites? Basal insulin: insulin type and rates Bolus: ICR and BG targets and TDD, ISF and Active Insulin Time Nutrition Notes (shaded)

20 Page 4 To be completed by Healthcare Providers Hypoglycemia DKA B/P,Ht,Wt Current A1C, Last A1C, A1C goal School/Daycare plan in Place Notes for Dietitian, Nurse, Physician

21 Let s hear from you If you have used the form and you have some constructive input to make the form more user friendly please submit your comments to carrie.haggett@dcpns.nshealth.ca

22 Partnerships, Quality, and Innovation (since 1991) DCPNS Registry Enhancements Pump Day 2015 November 13, 2015

23 DCPNS Registry Medical Eligibility Criteria # DC visits, # A1Cs in last 12m (and the values), Goal A1C, SMBG Freq & Use, DKAs, and S/Dcare plan at top of pump tab Partnerships, Quality, and Innovation (since 1991) 23

24 DCPNS Registry Easier Entry No more extra clicks just check the appropriate box/circle Enter Pump Start here & it will also appear under Present Treatment & vice versa Partnerships, Quality, and Innovation (since 1991) 24

25 DCPNS Registry Easier Entry Medical Eligibility (ME) area is always visible Critical to complete populates the NSIPP side with the ME date Partnerships, Quality, and Innovation (since 1991) 25

26 Partnerships, Quality, and Innovation (since 1991) Thank-you Questions?