United We Stand

A major theme of this week was unity. The RDs at FRMC are working on a big project, and a lot of collaboration with other healthcare professionals is taking place. 

​Keep reading to learn more about my third week working at Franklin Regional Medical Center. 

---

Just a quick recap of the daily doings:

I'm still responsible for a majority of our follow-up assessments. It is very interesting to watch the progress of our patients. My preceptor is trusting my ability to perform assessments more, and I'm hoping I will be able to start helping with initial assessments soon! 

In addition, I have been doing Coumadin education almost daily. One of the RDs observed me interacting with a patient this week and complimented my bedside manner. It was very encouraging and nice to hear that I am on the right track.

​I also had the opportunity to help "calculate" my first tube feeding this past week. I use quotations because there are actually nifty little formulary charts available for determining feed rates based on formula type. 

​While we calculate the patients needs using evidence based resources, the chart helps save time by providing information about calories, protein, free water, and fiber in an organized, easy-to-read format.

Although I love numbers and found tube feeding calculations to be pretty fun, these charts truly do help save time. When you have 20+ patients to assess per day, long-hand algebraic equations prove to be inefficient.

---

Diabetes Task Force

Let me preface with the beginning of our week. A drug representative came to talk about a new insulin injection called Tresiba, which has recently been approved by the FDA. Tresiba is a long-acting insulin that is used in combination with mealtime insulin and can be taken once per day, giving patients more control over their basal blood glucose. In addition to learning about Tresiba specifically, we also touched on the proper method of storing and administering insulin.

A major topic of discussion was that of adherence to insulin therapy, and how to increase adherence in patients. The population most likely to not adhere to guidelines are those in their 30s, who are the busiest with work, children, and aging parents. Methods of increasing adherence include keeping the injection pen within sight, adding the needle to a weekly pill box, and setting alarms on smartphones. Tresiba could help increase adherence simply by being a once-per-day dosage, making it easier to remember.

Another important method of increasing adherence to insulin therapy is education and training. The Certified Diabetes Educator in our office often encounters patients who have trouble managing their insulin simply due to improper administration. She has found that many patients using injection pens miss the key step of priming their pen with 2 units of insulin, which ultimately prevents the patient from receiving the full required dose.

---

​In addition to education, a main objective of the Task Force is to implement the Glycemic Control Algorithm, adapted by the American Association of Clinical Endocrinologists (AACE). This algorithm was developed to help simplify therapeutic regimen and optimize adherence.

With that being said, the big event of this week was the planning and development of the Diabetes Task Force, an initiative to help reduce hospital re-admissions related to diabetes and comorbidities by providing more outpatient education and training.

​The task force will be comprised of the Registered Dietitians, as well as representatives from other healthcare specialties, including Pharmacy, Nursing, Physicians, and Laboratory.

​Our Certified Diabetes Educator began by compiling research related to diabetes and hospital re-admission rates, in addition to the healthcare costs associated. She then developed a plan of action to present to the Director of Quality and Process Improvement, who agreed that there was an obvious need for the task force.

Next, a lesson plan was drawn up and pitched to each prospective representative of the task force. The lesson plan was well received by all participants, which brings the next challenge into view.

​Convincing the CEO.

---

The outlook for the Diabetes Task Force is very good, but convincing the upper ranks may be easier said than done. With enough evidence and professional support we are hoping to receive the funds necessary for launching a successful outpatient education program. The decision may sound like a no brainer to us, but monetary and fiscal policy can be tricky territory to navigate. 

Competencies:
CRD 1.3: Justify programs, products, services and care using appropriate evidence or data.
CRD 1.4: Evaluate emerging research for application in dietetics practice.
CRD 2.1: Practice in compliance with current federal regulations and state statutes and rules, as applicable and in accordance with accreditation standards and the Scope of Dietetics Practice and Code of Ethics for the Profession of Dietetics.
CRD 2.5: Demonstrate active participation, teamwork and contributions in group settings.
CRD 2.10: Establish collaborative relationships with other health professionals and support personnel to deliver effective nutrition services.
CRD 2.11: Demonstrate professional attributes within various organizational cultures. 
CRD 2.13: Demonstrate negotiation skills.