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![Page 1: Multidisciplinary Diabetes Team Activities in a 196 Bed Community Hospital Robin Southwood, Pharm.D, CDE and Beth Melvin, RD, MS, CDE.](https://reader035.fdocuments.net/reader035/viewer/2022062519/5697c0011a28abf838cc2a9e/html5/thumbnails/1.jpg)
Multidisciplinary Diabetes Team Activities in a 196 Bed
Community HospitalRobin Southwood, Pharm.D, CDE and
Beth Melvin, RD, MS, CDE
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Purpose•Describe the development of a multidisciplinary diabetes care team in a non-academic community hospital
•Report the activities and impact of the multidisciplinary care team.
•Describe contributions of students
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Mission
We, St. Mary’s Health Care System and CHE Trinity Health, serve together in the spirit of
the Gospel as a compassionate and transforming healing presence within our
communities.
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St. Mary’s Health System, Inc Services
• 196 acute care beds • Center for Rehabilitative Medicine• Home Health Care/Hospice• The Exchange/Wellness Center• Industrial Medicine• Highland Hills• Hospice House • Alzheimer Dementia Center
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Creation of St. Mary’s Diabetes Care Team
• Identification of needs• Program chair• Physician champion• Nursing representation• Pharmacy representation
• Identification of available resources• Program chair – Director of Diabetes Education• Physician champion- Hospitalist service• Nursing- Administrative and Bedside• Pharmacy- Quality assessment and clinical• Other- Ad hoc laboratory, dietary
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Inpatient Diabetes Support Team
Core Team
Dietetics
Students / Interns
Quality
NursingMedical Staff
Laboratory
Pharmacy
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Inpatient Diabetes Core Team
• Program Chair – Beth Melvin, RD, CDE• Physician Champion – Robert Meyer, MD• Mira Brown, RN, CDE• Robin Southwood, PharmD, CDE• Karen Turner, RN
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Inpatient Diabetes Support Team
• UGA Doctor of Pharmacy students – • 2 students for 5 weeks- total of 45 weeks per year
• UGA Public Health intern• 1 intern for 400 hours
• UGA College of Dietetics intern• 1 intern for 120 hours
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Diabetes Patient – From Admission to Discharge
• Supplement knowledge
• Identify barriers• Optimize therapy
• Offer outpatient education
• Physician appointments
• Prescriptions
• Knowledge evaluation
• Optimize therapy via standardized processes
• Screen for diabetes• A1c to assess
control• Hypoglycemia
Protocol
Admission Inpatient
Prepare for
DischargeDischarge
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Physician Champion Roles
• Liaison with medical staff– Committee – Surgeon
• Provision of Education
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Team Activities
• Education – Patient– Care providers
• Standardization of care– Develop processes
• Participation in care– Focus on patients with suboptimal care
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Participation in Care
• Identification of Uncontrolled Diabetes– A1C > 8%, BG > 200 x2, BG <100
• Knowledge and needs assessment• Communication of concerns and
recommendations to medical and nursing staff• Weekly Multidisciplinary Patient at Risk Meeting• Ensuring continuum of care
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Performance Measures S – Shoot for 15 Minute Hypo Recheck
H – Hypoglycemia Treatment Documentation
O – Outpatient DM Follow-Up Appointment
T – Teaching Booklet Given and Documented
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Jan-
12
Feb-
12
Mar
-12
Apr-
12
May
-12
Jun-
12
Jul-1
2
Aug-
12
Sep-
12
Oct
-12
Nov
-12
Dec
-12
Jan-
13
Feb-
13
Mar
-13
Apr-
13
May
-13
Jun-
13
Jul-1
3
Aug-
13
Sep-
13
Oct
-13
Nov
-13
Dec
-13
Jan-
14
Feb-
14
Mar
-14
Apr-
14
May
-14
Jun-
14
Jul-1
4
Aug-
14
Sep-
14
Oct
-14
Nov
-14
Dec
-14
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Adherence to Hypoglycemia Treatment Pro-tocol 2012 - 2014
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Hypoglycemia Treatment Documentation
Nov-14 Dec-14 Jan-15 Feb-150
102030405060708090
100
82.5 78.9 79.9 81
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15 Minute Hypoglycemia Recheck
Nov-14 Dec-14 Jan-15 Feb-150
102030405060708090
100
72.264 62 60
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Discharge Follow-up Appointment
Jan Jun-14 Sep-14 Nov-14 Dec-15 Jan-15 Feb-150
102030405060708090
100
Percent of Follow-up
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Documentation of Teaching Booklet
Jan-14
Feb-14
Mar-14
Apr-14
May-14
Jun-14
Jul-14
Aug-14
Sep-14
Oct-14
Nov-14
Dec-14
Jan-15
Feb-15
0%
20%
40%
60%
80%
100%
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Additional Performance Improvement
• Additional Hypoglycemia Measures– Cause Identification– Prevention– HEN – BG < 50 mg/dl
• Patient Satisfaction• Glucometrics
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Amount of Time Spentin Patient Interactions
Jan-08
Mar-
08
May
-08Ju
l-08
Sep-08
Nov-08
Jan-09
Mar-
09
May
-09Ju
l-09
Sep-09
Nov-09
Jan-10
Mar-
10
May
-10Ju
l-10
Sep-10
Nov-10
Jan-11
Mar-
11
May
-11Ju
l-11
Sep-11
Nov-11
Jan-12
Mar-
12
May
-12Ju
l-12
Sep-12
Nov-12
Jan-13
Mar-
13
May
-13Ju
l-13
Sep-13
Nov-13
Jan-14
Mar-
14
May
-14Ju
l-14
Sep-14
Nov-14
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
90.00
100.00Hours
• Monthly time spent in direct patient interactions (January 2008 vs July 2014)• Increased from 7.7 hours to 66.2 hours spent interacting with patients• 740% increase in patient interactions
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Average Glucose Value
Sep-0
7
Nov-07
Jan-0
8
Mar-
08
May
-08
Jul-0
8
Sep-0
8
Nov-08
Jan-0
9
Mar-
09
May
-09
Jul-0
9
Sep-0
9
Nov-09
Jan-1
0
Mar-
10
May
-10
Jul-1
0
Sep-1
0
Nov-10
Jan-1
1
Mar-
11
May
-11
Jul-1
1
Sep-1
1
Nov-11
Jan-1
2
Mar-
12
May
-12
Jul-1
2
Sep-1
2
Nov-12
Jan-1
3
Mar-
13
May
-13
Jul-1
3
Sep-1
3
Nov-13
Jan-1
4
Mar-
14
May
-14
Jul-1
4
Sep-1
4
Nov-14
120
130
140
150
160
170
180
190
200
BG Average (mg/dl)Linear (BG Average (mg/dl))Lower TargetUpper Target
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Hypoglycemic Events
20082010
201241306
4136541426
4148741548
4160941671
4173041791
4185241913
419740
0.51
1.52
2.53
3.54
Hypoglycemia (%)Linear (Hypoglycemia (%))Critical Hypoglycemia (%) Linear (Critical Hypoglycemia (%) )
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Drug Therapy Recommendations
•July 1, 2013 to June 30, 2014 – 897 documented recommendations•746 (83%) of 897 documented recommendations were accepted•239 (59%) involved Doctor of Pharmacy students
•Recommendations include:•Hypoglycemia protocol order / A1C lab order 377 (28%) •Insulin therapy – 412 (48%) of which 301 (73%) were accepted•Oral Medication Therapy- 84 (9.4%) of which 54 (64%) were accepted
•Insulin Pump Assessment- 13 (1.4%) •Recommendation of Hospitalist consultation for diabetes management- 6 (0.7%)
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Assessment of Team Performance
•Creation of a multidisciplinary team resulted in a 760% increase in time devoted to patient education.
•With a multidisciplinary team, the wide variety of interventions have helped improve patient quality care.
•Diabetes medication safety • Implementation of computer based algorithm to facilitate management of continuous insulin infusion therapy
•Streamlining hospital diabetes medication formulary resulting in estimated savings of $20,000 annually
•7 Posters presented at National Meetings since 2012
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Team Achievements
• Joint Commission Disease Specific Certification in Advanced Inpatient Diabetes Management.– Original 2012 (2nd hospital in Georgia)– Recertification 2013 and 2014
• Formulary management has reduced costs approximately $33,432 annually
• Collaboration with UGA College of Pharmacy
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Doctor of Pharmacy Student Participation
• Standardization in student orientation– Assigned pre-APPE readings
• Active engagement in patient evaluation starting day 1
• Skill check off for patient education / device instruction
• Skill check off for documentation in electronic medical record
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Doctor of Pharmacy Student Participation
• Daily assessment of diabetes pharmacotherapy and presentation to Core Team
• Development of recommendations for changes in pharmacotherapy
• Participation in patient education • Participation in Quality Assessment Projects
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Future Growth Opportunities
• Recruitment of New Endocrinologist• Residency Program begins 2015• Medical College of Georgia / UGA partnership
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Questions