Diabetes Management Strategies

1. Diabetes Management Strategies By: Raimee Schertzberg, Meagan Smoyer, Cindy Thornton, John Woodcox

2. Why This Service Is Necessary • Diabetes type I and II, as well as prediabetes, can both be managed with diet, exercise, and medications • The effects of the disease on an individual’s overall physical health can be detrimental if not properly monitored or compliance poses an issue • Complications from diabetes may include heart disease, obesity, kidney disease (including failure), neuropathy, poor wound healing, amputation of limbs, retinopathy (which leads to blindness) stroke, and high blood pressure • The cost of diabetes and its complications is astoundingly in the hundred billion dollar range (American Diabetes Association, 2011 • MidMichigan Health offers diabetes programs to reach the community, the services are provided on an outpatient basis only. It is the goal of Diabetes Management Strategies to place home care clients with a diagnosis of diabetes or prediabetes in a “Diabetic Boot Camp” for the length of time they are on service

3. Mission Statement • MidMichigan Healthcare has a mission statement that focuses on "Excellence." • We strive to continue with that focus by providing essential, comprehensive, and user friendly diabetic education to the clients that are being served in the Mid-Michigan Healthcare-Home Care arena. • We strive to provide easily comprehendible educational and resource information to clients, and to give them the tools to maintain proper management of their diabetes. • Our goal is to reduce re-hospitalizations and other diabetic associated complications for clients who are homebound and need help with management of their diabetes.

4. The philosophy of the program provided by Diabetes Management Strategies reflects the vision and goals of the entire organization.  Our focus is on the patient and meeting any needs that each may have.  We allow patients to live a more healthy life by gaining knowledge and control over a diagnosis of diabetes. As part of MidMichigan Health, we hold the values of excellence, integrity, teamwork, and accountability to be fundamental. Philosophy

5. We believe that every patient has the right to appropriate education about his or her diagnosis. • We strive to meet the personal needs that each patient possesses in order to provide that education. • We believe that each patient has a specific way of learning and will keep our staff up to date on education strategies to most effectively meet these needs. • We will provide the most up to date medical information and teaching to keep our patients on the edge of modern medicine.  • We vow to listen to the voices of patients to make each autonomous in their care.  • We appreciate the individuality of each family and respect the cultural, racial, ethnic and religious traditions, which make them distinct. Philosophy

6. Organizational Goals • Ensure current diabetes information and services are available to diabetic patients and their families. • Ensure that patients have the medical equipment needed to monitor their blood sugar. • Ensure communication with patient’s physician regarding education and services provided. • Ensure that all diabetic patients have access to the program and its resources. • Ensure that patients are not re-hospitalized due to complications associated with diabetes. • Ensure that diabetic services are being provided to patients that are homebound.

7. Organizational Objectives • To educate diabetic patients on the proper procedure for checking their fasting blood sugar. • To educate diabetic patients and their families regarding the signs and symptoms of hypo/hyperglycemia and the appropriate actions to take. • To educate diabetic patients about the possible health risks associated with improper management of diabetes. • To provide education to diabetic patients on how to check their feet for sores or wounds and the importance of routine eye exams. • To educate diabetic patients how to take their medications or injectable insulin. • To increase self-management of poorly controlled diabetes by helping patients improve overall health and well-being through the use of a multidisciplinary healthcare team.

8. Organizational Chart

9. Job Descriptions Medical Director Office Manager Office managers are best known for their support of staff members while promoting patient satisfaction and ensuring agency policies and procedures are being appropriately followed. Holds the responsibility to supervise and manage nurses, social workers, and dietary services while collaborating with the supervisor of the scheduling department. Communicate needs to the Medical Director and keep staff informed Ensure patient and staff needs are being met • It will be the responsibility of the endocrinologist (program medical director) to ensure that appropriate policies and regulations are implemented and to monitor the “standard of health.” • The director of operations will be responsible for making sure daily operations are running smoothly while being a support system to the office manager and communicating providing directions and support. • Participate in marketing activities for the business’ enhancement and profitability to ensure goals in customer satisfaction, clinical outcomes, and financial performance are met” (MidMichigan Home Care, 2012).

10. Job Descriptions Dietician Wound-Care Nurse The wound nurse can provide diabetic ulcer education and wound care Be responsible for addressing patient needs and enlisting the help of the social worker if necessary Provide proper techniques and supplies that will promote healing and prevent infection Ensure that patients understand the importance of wound care and provide follow up and referrals if necessary • Provide assistance in meal planning, monitoring of blood sugar, and responses to hypoglycemia and hyperglycemia • Have Patients use food diaries and blood sugar logs in order to provide feedback regarding appropriate food choices • Teach proper diet using examples from these logs • Provide information on how exercise affects blood sugar levels and how it is beneficial for the diabetic patient.

11. Job Descriptions Diabetic Teaching Nurse Social Worker The role of the social worker can assist in evaluating “social, emotional, financial, and environmental factors related to the patient’s illness, response to treatment, and adjustment to care as well as identifying stressors that exacerbate the illness” (MidMichigan Home Care, 2012). Through this evaluation, appropriate services and/or referrals can be made as community resources and support services are assessed. Will collaborate with the Office Manager, Wound Care nurse, Dietician, and Diabetic Teaching Nurse to meet the needs of patients. • As part of the admission process, the diabetic teaching nurse will provide a thorough assessment to include vital signs, skin, nutritional value, co- morbidities, barriers to teaching or meeting goals, caregiver support (if necessary), and willingness or motivation for change and/or overall improvement of health. • Upon completion, this nurse is to request appropriate referrals for social workers • The diabetic teaching nurse will create a schedule of visits and events to take place at each home visit and provide appropriate documentation in the patient’s chart. • Will collaborate with the Office Manager, Wound care nurse, Dietician, and Social Worker to provide the best care for patients.

12. Sample Job Advertisement Diabetes Management Strategies Join Our Team Today! The positions within our organization through MidMichigan Medical Center offer, autonomy, freedom, and focus for the patients we serve. This allows for care providers to organize their day in whichever way suits the individual, and maximizes the impact we have on effective diabetes management. Diabetes Management Strategies offers room for unlimited clinical growth, and the ability to be a part of a team that makes a difference in the fight against diabetes. As a member of the Diabetes management education team, you have a focused expertise area, which allows for greater impact with the patients we serve. Diabetes Management Strategies is looking for a dedicated Endocrinologist, a specialized dietitian with expertise in diabetes management, and two full time Nurses with specific training or certifications in diabetes management to be a part of a team built to make difference. Please forward your resume and cover letter to Diabetes Management Strategies: P.O. Box 123, Midland, MI. 48640, or apply online @ Monster.com.

13. Marketing Plan & Cost of Advertising • The employment advertisement will run in the Midland Daily News that Mid-Michigan utilizes for employment opportunities. The cost for running this advertisement will be $158.00 (Personal Communication, Angela, MDN). • The online version of this circular has a link when you access the classified section that directs the user to Monster.com, and the cost for this portion is $90.00 (Personal Communication, Angela, MDN). • The total cost for placing this employment opportunity is 248.00 (Personal Communication, Angela, MDN). • The final arena in which we will advertise is in the American Journal of Nursing (AJN). • The cost for running this employment advertisement will be $2675.00 for a 1/8th page section in the journal (AJN, 2012).

14. Budget Plan FTE’s For Staffing: • Wound nurse • 2 Registered nurses • Dietician • Manager • Director • Endocrinologist

15. Salaries • Salaries for Staff per year: • Wound nurse $53,300/year at $25/hr • 2 Registered nurses $49,900/ year each at $24/hr • Dietician $41,600/year at $20/hr • Manager $60,000/year at $29/hr • Director $76,000/year (indeed.com) • Endocrinologist $118,000/year (indeed.com) • Productive hours (without vacation, holiday & sick time) would be 1872 • Non-productive hours are 208 with 15 days of vacation, 7 days of holiday, and 4 sick day

16. Hours of Operation Monday- Friday from 8am-5pm

17. Budget Government Reimbursement Supplies & Operating Expenses Our supplies should include: Glucometers/test strips/lancets Wound care supplies Computer equipment Office supplies Teaching resources Lab supplies Operating expenses should include: Any applicable diabetic seminars for staff to have the most current information regarding diabetes to ensure that up to date care is being provided. • MidMichigan Home Care’s primary source of reimbursement is provided by Medicare Part A while Medicaid, other private insurance companies, and charitable funds make up the remaining sources of reimbursement for services provided

18. References American Diabetes Association (2011). Diabetes statistics. Retrieved from http://www.diabetes.org/diabetes-basics/diabetes-statistics/ Center for Medicare and Medicaid Services. (n.d.). Retrieved from http://www.medicare.gov/publications/pubs/pdf/10969.pdf Mayo Clinic (2012). Type 1 diabetes. Retrieved from http://www.mayoclinic.com/health/type-1-diabetes/DS00329 Mayo Clinic (2012). Type 2 diabetes. Retrieved from http://www.mayoclinic.com/health/type-2-diabetes/DS00585 MidMichigan Home Care. (2012). Competency-based job description and performance standards. Retrieved from the J drive of MidMichigan Home Care public folder MidMichigan Health. (2011). MidMichigan launches innovative multidisciplinary diabetes program. Retrieved from http://www.midmichigan.org/about/news/2011/midmichigan-launches-diabetes-program/ Yoder-Wise, P.S. (2011). Understanding and Designing Organizational Structures. In, Leading and managing in nursing (pp.137-156) 5th ed. St. Louis, MS: Elsevier Mosby. American Diabetes Association (n.d.). Diabetes basics. Retrieved from http://www.diabetes.org/diabetes-basics/prevention/pre-diabetes/