Advocating for Occupational Therapy s Role in Diabetes Management. Milwaukee VA Medical Center Abbey Lacey, OTS

Transcription

1 Advocating for Occupational Therapy s Role in Diabetes Management Milwaukee VA Medical Center Abbey Lacey, OTS

2 Objectives! Overview! Advocacy project! Case study

3 Overview! Type II diabetes results when the body cannot use insulin properly.! Triggered by lifestyle factors! Accounts for approximately 95% of all cases.

4 Medical Management! When diabetes can no longer be managed by diet and exercise alone, individuals will begin insulin therapy.! Type of insulin therapy depends greatly on the individual! Typically 2-4 insulin injections per day! Recommend at least 2 blood glucose readings per day

5 What Does This Require of a Client?! Maintain an organized schedule! Adjust the dosage! Prepare and administer insulin! Log and track blood glucose readings 1

6 Co-morbid Complications! Hypoglycemia/ hyperglycemia! Hypertension! Stroke! Cardiovascular disease! Low vision! Kidney disease! Peripheral vascular disease! Peripheral neuropathy! Psychosocial complications

7 Advocacy Project

8 Key Research! An interdisciplinary team approach is preferred.! Diabetes self-management education improves healthcare outcomes.! There are seven imperative self care behaviors required for self management.

9 Seven Self Care Behaviors 1. Healthy eating 2. Being active 3. Monitoring 4. Taking medications 5. Problem solving 6. Healthy coping 7. Reducing risks

10 Phase 1: Needs Assessment Informal therapist interview! Rarely addressed diabetes related concerns! Uncertainty regarding OT role in diabetes care! Interest in expanding role

11 Review of Facility Resources! Full time certified diabetes nurse educator (CDE RN)! Extensive educational materials! Lifestyle groups

12 Meeting with CDE RN Self management concerns:! Low vision! Decreased sensation! Difficulty performing foot care routine

13 Summary of Needs Assessment Strengths! Onsite access to interdisciplinary care! Resources available to veterans free of charge! Full time CDE RN Barriers! Lack of understanding regarding OT s role! Lack of appropriate educational handouts! Difficulty with specific self cares

14 Phase Two: Education and Advocacy! Adaptive equipment! Activity analysis! Sample daily routine! Review of OT lifestyle groups! Review of interventions to address decreased strength, dexterity, and sensation

15 Phase Three: Resource Development! Lack of information about OT services in the DSME course.! Foot care handouts were not designed for individuals with physical barriers to completing a foot care routine. 2

16 Phase Four: Solicit Feedback Informal interview:! OT practitioners! The certified diabetes nurse educator! Veterans

17 Case Study: Mr. H! 63 y/o male with a history of type 2 diabetes, hypertension, peripheral neuropathy, alcoholism, tobacco abuse, and depression.! Presented to the emergency department with a diabetic ulcer on his right foot.! The wound was cleaned/dressed and Mr. H was sent home with instructions to closely monitor the wound and contact his physician should it worsen.

18 Case Study: Mr. H! One month later, Mr. H presented the ED with complaints of worsening pain and odor from the wound. He was diagnosed with wet gangrene.! He also had a small ulcer on his left foot.! Mr. H was admitted to the hospital for a course of IV antibiotics and monitoring.! Within 24 hours of admission, Mr. H underwent a below the ankle amputation of his right foot due to spreading infection.

19 Case Study: Mr. H Traditional team:! Physician! Diabetes nurse educator! Dietician! PT! Psychologist New members:! OT! Recreational therapist

20 Traditional Team Member Physician Diabetes nurse educator Dietician PT Psychologist Role Medical management of diabetic ulcers, pain, and insulin Reviewed blood sugar monitoring, insulin injections, and how to manage high/low blood sugar Consultation session to review basic dietary guidelines and the importance of eating regular, balanced meals Therapeutic exercises, home exercise program, wheelchair fitting, specialized shoe for left foot Addressed negative feelings and found constructive outlets for emotions

21 Additional Members Occupational therapy:! Examined daily routine! Developed schedule! Provided adaptive equipment! Created visual reminder for medication management! Referral to lifestyle group. Recreation therapy:! Explored hobbies! Set goals for community reintegration upon discharge

22 Lessons Learned! OT practitioners are a valuable member of the interdisciplinary team.! It is imperative that practitioners continue to clarify and advocate for their role on the DISK_IMG interdisciplinary team to improve outcomes for clients and further the profession.! Advocating for your profession allows you to learn more about other professions.! Advocacy can feel like a full time job.

23 Thank you! Sarah Foidel, OTR/L- Capstone advisor! Rachel Schutz, OTR/L- Community advisor

24 Questions?

25 References! American Diabetes Association. (2016). Statistics about diabetes. Retrieved from American Association of Diabetes Educators. (n. d.). AADE 7 self-care behaviors. Retrieved from American Occupational Therapy Association. (2011). Occupational therapy s role in diabetes self-management. Retrieved from files/aboutot/professionals/whatisot/pa/facts/diabetes%20fact%20sheet.pdf! Druss, B. D., Marcus, S. C., Olfson, M., Tanielian, T., Elinson, L., & Pincus, H. A. (2001) Comparing the national economic burden of five chronic conditions. Health Affairs, 20(6), doi: /hlthaff ! Mensing, C., Boucher, J., Cypress, M., Weinger, K., Mulcahy, K., Barta, P.,... Adams, C. (2000). National standards for diabetes self-management education. Diabetes Care, 23(5), doi: /diacare ! Steed, L., Cooke, D., & Newman, S. (2003). A systematic review of psychosocial outcomes following education, self-management and psychological interventions in diabetes mellitus. Patient Education and Counseling, 51(1), /S (02) ! Sokol-McKay, D. A. (2011). Occupational therapy s role in diabetes self-management. Retrieved from Diabetes.aspx

26 Image Credits syringes&source=lnms&tbm=isch&sa=x&ved=0ahuke wi4hmsxbtoahvjzmmkhykrb4oq_auicsgc&biw=1202&bih =699#imgrc=r6GzVVj4QXoEdM%3A 2. %20for%20People%20with%20Diabetes%20English.pdf