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Learning Session 2 October 31 st , 2016

Diabetes Collaborative. Learning Session 2 October 31 st , 2016. Mangere Health Centre. Care Bundle Data. What does the data say?. What does it mean for you The care bundle showed that there was a decline in the assessment for the risk & presence of complication of diabetes.

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Learning Session 2 October 31 st , 2016

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  1. Diabetes Collaborative Learning Session 2October 31st, 2016 Mangere Health Centre

  2. Care Bundle Data

  3. What does the data say? • What does it mean for you The care bundle showed that there was a decline in the assessment for the risk & presence of complication of diabetes. • What does it mean for your patient Patient will slip through the gaps. • What does it mean for the work within your practice We have in our PMS a form called “Diabetes Nurse Form”. This form is not always utilised correctly. We have now implemented a protocol to use this form at our Nurse 6mnthly Diabetes check to ensure all aspects of diabetes risk & presence of diabetes complications are checked and reviewed.

  4. Diabetes form to prompt thinking to ensure complete package of care is provided

  5. Diabetes Education

  6. Changes currently being tested • Describe the changes you are testing based on the learning's from the Care Bundle / Practice / PHO or DHB data • Initiation of Diabetes Nurse Clinic (Weds & Thurs morning/flexible) • Pt own medical team to initiate conversation/referral to nurse clinic • Pt own nurse to be present during diabetes nurse clinic appointment to hand over knowledge/skills set to PN with the hope they will continue plan of care post-discharge from clinic & to keep immediate team in the loop (not possible all the time due to time constrains with PN responsibility) • Establishing set times for each practice to have focused dedicated time for DCIP management (contact pt/refer to Harri’s clinic/book in own clinic etc) • Mobile phone telecommunication/emails • Monthly meeting for all nurses to share current results from the care bundle & follow up on DCIP progress from last meeting • White board in Staff Room (HbA1c results)

  7. Learnings • Key learnings from the changes you tested • Pt ENGAGEMENT is the key to success LISTEN CAREFULLY TO THE PT. Read between the lines (enabler) Health Literacy (enabler) Relationship/Trust (enabler) Pt empowerment (enabler) 2) Making holistic judgment calls (know your pt lifestyle well & mould your treatment plan to fit. Eg: cultural diet, affordability, habits) • Never change your vibe regardless of your mood. • Never base TODAY’s treatment plan on historical facts. • Go into the engagement with a FRESH LENS (no pre-conceive judgement)

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