CM Develops Diabetes Education Initiative
by Bobbi Rosenkranz, RN, CCM, CRRN, NMCC
My name is Bobbi Rosenkranz, RN, CCM, CRRN, NMCC, DOD, MOD, SOD, AOD, NIDDM. You’re probably familiar with the CCM, CRRN and perhaps, the NMCC designations after my name. But what do the last five acronyms stand for? Simple — I’m the daughter of a diabetic, mother of a diabetic, sister of a diabetic, aunt of a diabetic, and I have non-insulin dependent diabetes mellitus or NIDDM.
As a Field Case Manager for Health Net, I work with members admitted to skilled nursing facilities for short-term rehabilitation. Over the past few years, I’ve noticed an increasing number of admissions involving diabetes as a primary diagnosis or co-morbidity, and I’ve also noticed the lack of documented diabetic education being offered in facilities. My plan was to develop a program to identify our diabetic population, assess their knowledge of the disease and determine their educational needs during admission. I also wanted to help develop a diabetic education program for the facilities to implement for our members.
My proposed program involved a myriad of people, including myself, the facility case manager, their nursing staff, physicians, Health Net’s Disease/Complex Management team, and most importantly the member. What I set out to do mirrored the definition of case management in the Standards of Practice . . . “assessing, facilitating, educating, problem solving, exploring options to care, encouraging appropriate use of services, striving to achieve client empowerment, advocating for client and payer.”
I designed a very thorough questionnaire, which was faxed to the member. It addressed whether the member had a glucometer, who checked blood sugars, how often, average blood sugar range, diet and compliance, complications and specific questions for insulin dependent diabetes mellitus (IDDM). The facility section explored what teaching, if any, had been provided by the facility.
Based on responses, I was able to individualize the most appropriate care plan for each member. Some members indicated that they were compliance with their medications and diet, had appropriate blood sugars and did not need further follow-up. Others required significant teaching related to signs/symptoms of hypo/hyperglycemia, diet management, insulin administration, etc. In those cases, a letter was sent to the facility requesting diabetic teaching and specifically outlining those areas the member had identified. If a member reported a high blood sugar range, an HgbA1c was requested.
During the first three months, my statistics indicated that 17 percent of members did not have a glucometer, and prior to discharge they were given prescriptions and were taught how to check their blood sugars. Sixty-seven percent reported they had never had formal diabetic teaching; 38 percent were not on any special diets; and 36 percent reported significant complications related to diabetes.
This program is successful. Earlier identification of our diabetic population, and appropriate intervention and education may help to reduce diabetic related complications and future hospitalizations. In the first three months, 40 percent of responders were referred to Health Net’s Disease Management and Complex Case Management Departments.
Many of our facilities are required to have disease management programs as part of their certifications, and this program allows them to individualize appropriate care plans for each of their diabetic patients as well.
