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Announcements

Feather River Hospital Diabetes Education Annual Diabetes Education Med ICU Report Beverly Thomassian, RN, MPH, CDE, BC-ADM Diabetes Program Manager May 9, 2017. Announcements. Diabetes Stats: 1 in 3 people have prediabetes 1 in 10 people have diabetes

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Announcements

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  1. Feather River HospitalDiabetes EducationAnnual Diabetes Education Med ICU ReportBeverly Thomassian, RN, MPH, CDE, BC-ADMDiabetes Program ManagerMay 9, 2017

  2. Announcements • Diabetes Stats: • 1 in 3 people have prediabetes • 1 in 10 people have diabetes • 20% of people over the age of 60 have diabetes • 45% of people in America are hyperglycemic • Nationally, only 10% of people with diabetes are referred to Diabetes Self Management Training Classes or to see a dietitian • Medicare will cover Diabetes Prevention Programs starting in 2018. • To keep our program robust and sustainable, we need to constantly strive to increase and maintain our referrals

  3. Updates • Georgia Juney is now Triage Care Manager at Family Health Center • Dawn DeSoto, RD, CDE is now providing inpt and outpatient diabetes education • We have updated our Insulin Scale • Keeping an eye on hypoglycemia • Hoping to provide prevention classes • Strides for Diabetes Prevention Fair • Successes for the year

  4. Resources – Locations Office location: • 1933 Peach Lane - Outpatient Surgery (on campus) Designated room for 1:1 appointments. Class location: • Feather River Hospital Fireside Lounge Support Group • Feather River Hospital Board Room

  5. Diabetes Survival Camp Program Components Meet with Diabetes Nurse Educator for 1 hour individual appointment: • Goal setting • Problem solving • Refer to RD Classes: • 4 consecutive Tuesdays from 2:30- 4:45 • Graduate = Attends individual + 4 classes Ongoing Care • 3-6 months after graduation Request patient get another A1c • Mail out written follow-up questionnaire

  6. Mission Statement Diabetes Survival Camp supports participants to survive and thrive with diabetes. We are here to collaborate with participants to promote the best diabetes self-care possible for each individual.

  7. Goal - 175 Outpt Referrals a Year Results – 183 outpt referrals(131 MD; 15 MNT; 37 self referrals) • 32% participated in group classes • 31% participated in 1:1 only • 36% non-participants* • Nonparticipants: 52% of patients set up initial appointment, (but did not keep or reschedule missed appointments) • 48% – no participation (no response, no interest)

  8. Main Referring MDs with 6 + 2015-2016 • Arnott(14) • Vance (13) • Bush, C (8) • Darwin (7) • Sloop, R (7) • Smiley (7) • Aung (6) • Curtis, J (6) • Owens, M (6) • Vertolli (6) • Turner, Badour, Herring, Lee (5) 2014-2015 • Aung (12) • Vance (7) • Arnott (6) • Owens (5) • Bush (5) • Darwin, Lee, Layne, Badour (4) * Bush (Oroville); Owens (Pdse. Immed. Care)

  9. Revenue, Income, Expenses • On average – each hour generate $50 of revenue • $432 – Amount Medicare reimburses for 10 hours • 2016 – 559 billable hours - $27,950 • 2015 – 577 billable hours - $28,850 • 2016 Income - $27,950+ $ 2,180 for Strides = $30,130 • Covers about 50% of Department expense

  10. Summary of Outcomes A1C Results: • Overall decrease of 1.45% Weight Results: • 16.3 pounds avg reduction* *Of the (33%) who returned follow up assessment form

  11. Other Outcome Measures: Behavioral Goals Average Weight Loss: 16.3 lbs. Frequency of Exercise 5-7 days per week: 46% 3-5 days per week: 5% 1-2 days per week: 25% 0 days per week: 23% • Type of Exercise • Walking • Treadmill • Stretching • Sit ups • Stationary bike • Construction • ‘Chasing a toddler’

  12. Other Outcome Measures • 100% said they would recommend to other • Overall program rating: • 92% Excellent • Did the program meet your expectations? • 92% yes • Pre/post test: increase knowledge by 14%

  13. Participant Comments “I’m much more motivated & exercising more. Feeling better educated about diabetes & my life going forward.” “This class helped me whip depression. It is not a death sentence.” “It was invaluable the way the class equipped me to face diabetes! It’s a positive starting point to a life journey.” “I am and will continue to work on my weight and controlling blood sugar.” “I feel diabetes is manageable and not as fearful as when first diagnosed.” “I appreciated listening to others with the same disease.” “I’m more aware of how important it is to take it seriously and to prevent problems.” “I enjoyed the approach of the educators. I would stress to others that this education is essential.” “I feel much less anxiety and no longer feel overwhelmed.” “I am a healthier person.”

  14. Scholarship Program Service • We turn No One Away! • Students who benefitted in 2016 • individual sessions • group sessions

  15. Diabetes Prevention Program Covered 2018 • 30% of Americans have diabetes • 90% don’t know they have it • Prevention programs can delay or prevent diabetes by 58% • 16 week program focused on behavior change Would Providers refer at risk pts to a Prevention Program?

  16. Support Group – 1st Tuesday of Each Month • 20+ people attend each group • Arrive early and already engaged in support • Attended & showed interest in sessions with guest speakers • Relaxed Group Appt - Opportunity to provide “casual coaching” and help with management plans.

  17. Strides For Diabetes – September 25, 2016

  18. Strides Outcomes All proceeds from the event provide diabetes education scholarships for un/underinsured people in our community • 180 people participated (3 hospital teams; 10 community teams) • Engaged youth • Raised money for scholarships • Promoted Community Awareness and Fitness

  19. Walk & Run Teams Hospital Teams • Administration (The “A Team”) • Rural Health Clinic: (Beating Diabetes w/ our Feeties) • Cancer Center (Keto Killers) Community & Family Teams • Pathfinders (Paradise Prayer Warriors) • Berkowitz Fitness Team • Butte College Nursing Students • CSU Food & Nutrition Assn. • Gone Bananas Family Team • HAES – Health at Every Size • Marshall Reed Family Team • PHS Cross Country Team • Parents of PHS Cross Country Team • Sweet Soles

  20. Next Strides for Diabetes Event • Sept 24 Please bring your families and friends. Join us All Proceeds go toward our Education Scholarship Fund

  21. Successes for the Year • Strides for Diabetes • Diabetes Resource Nurse Program • New Grad education • Support group • Community Prevention workshops • Insulin Scale Update • Community involvement

  22. Inpatient Diabetes Update

  23. Blood Glucose Above Normal • Pre Diabetes • Fasting Glucose = 100-125mg/dl • A1c 5.7 – 6.4% • Diabetes • Fasting Glucose = 126 mg/dl + • Random Glucose = 200 mg/dl + • A1c 6.5% + “Any blood glucose above 140 requires treatment” Umpierrez et el

  24. General Hospital Stats • 30% admitted have diabetes • 12% have hyperglycemia, but not diagnosed with diabetes. • At FRH, our goal is to draw A1c on all pts admitted with diabetes or those with hyperglycemia

  25. FRH Inpatient Glucose Goals60% of the time get Pre meal glucose to 80-140 Post meal glucose < than 180

  26. 2016 Preliminary Chart Audit Details 2016 –July, Aug, Sept • 50 charts audited – 1005 fingersticks • All pts w/ diagnostic code 250.00-250.99 (anywhere in diagnosis) • Retrospective randomized electronic chart audit • LOS > 3 days, < 20 • Avg LOS = 5 days

  27. PreMeal Goal < 140 Post Meal Goal <180 Blood Glucose Goals and Results We achieved this goal • 2016 – 46% • 2015 - 42% No BG less than 40. How can we achieve 60% of time? How can we decrease hypo? We achieved this goal 2016– 67% 2015 - 52%

  28. Average Blood Glucose Premeal BG Goal: 80 -140 AvgPremeal BG = 155 • 2016 - 155 • 2015 - 164 HS BG Goal: 80-180 Avg HS BG = 163 • 2016 - 163 • 2015 - 167

  29. Low Blood Glucose Distribution

  30. Insulin Summary Lantus seemed to be the biggest contributor to am hypoglycemia • Bolus Insulin • Scale adjusted 68% of time to improve BG Control • Mild Insulin Scale – 66% of patients • Moderate Insulin Scale – 34% of patients • Adjusted on 6 patients • Not adjusted on 7 patients • Aggressive Scale – 0% of patients • Lantus - Started on 34% of patients • Dose adjusted 29% of time

  31. Insulin Scale Updates • To improve outcomes we made some significant changes to the Insulin Progressive Scale Order Set • Provide insulin when the glucose is 80-150 (instead of starting at BG of 120).  • We also intensified aggressive scale based on MD feedback.

  32. In case of Hypo or Hyperglycemia • Under Step 2, staff are given the option to provide bolus insulin after meals if unsure if patient will eat • Under Step 3, staff can increase scale if BG is more than 160 x 2 • (used to read more than 200 x 2). • Also under Step 3, if BG < 80, please encourage staff to decrease by one  pre-meal scale AND decrease basal insulin (Lantus) by 20%.

  33. How we Monitor BG Results • Run weekly glucose report • Conduct an annual chart audit of blood glucose control. • Keep in close contact with Pharmacy to see if D50 is being used • Feedback from Providers and Staff

  34. Thank You on behalf of all the people living with diabetes

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